Basic Information
| Provider Information | |||||||||
| NPI: | 1720284128 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMOCK | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | INTERNAL MEDICINE, SE615 GH | ||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522421009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193846501 | ||||||||
| FaxNumber: | 3193563086 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWKINS DR | ||||||||
| Address2: | INTERNAL MEDICINE, SE615 GH | ||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193846501 | ||||||||
| FaxNumber: | 3193563086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 39024 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD-39024 | IA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | R8159 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.