Basic Information
| Provider Information | |||||||||
| NPI: | 1427003011 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OBSTETRICS AND GYNECOLOGY SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5350 EASTERN AVENUE | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633551853 | ||||||||
| FaxNumber: | 5633550327 | ||||||||
| Practice Location | |||||||||
| Address1: | 5350 EASTERN AVENUE | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633551853 | ||||||||
| FaxNumber: | 5633550327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 11/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | GRAHAM | ||||||||
| AuthorizedOfficialFirstName: | JENIE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5633551853 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.