Basic Information
| Provider Information | |||||||||
| NPI: | 1972561868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NUPATH, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2660 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507042660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192333044 | ||||||||
| FaxNumber: | 3192330722 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 S GEAR AVE | ||||||||
| Address2: | |||||||||
| City: | WEST BURLINGTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 526551679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3197681000 | ||||||||
| FaxNumber: | 3192330722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 07/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | GALE | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3197681000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.