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FELIPE COSCOLLUELA JAVIER III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2710 SAINT FRANCIS DR STE 411, WATERLOO, IA 50702-5634
(319) 272-5000
(319) 272-5825
Mailing address
2710 SAINT FRANCIS DR STE 411, WATERLOO, IA 50702-5634
(319) 272-5000
(319) 272-5825

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
036-100466
IL
207K00000X
Allergy & Immunology Physician
Primary
32545
IA
208000000X
Pediatrics Physician
036-100466
IL
208000000X
Pediatrics Physician
32545
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
203896410
MO
01
33628
BLUE CROSS BLUE SHIELD
01
421527584
TRI-CARE GROUP NUMBER
05
421527584003
IL
01
42152758408
JOHN DEERE
05
O278374
IA
Enumeration date
05/27/2005
Last updated
03/17/2018
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