Individual
FARID FREDERICK MANSHADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
36 W PARK LN, WATERLOO, IA 50701-5178
(319) 234-0109
Mailing address
36 W PARK LN, WATERLOO, IA 50701-5178
(319) 234-0109
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
27493
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0298216
—
IA
01
—
044982
BC/BS
IA
01
—
250004438
RR MEDICARE
IA
01
—
42137207602
JOHN DEERE
IA
01
—
A006219
CHAMPUS
IA
Enumeration date
01/09/2006
Last updated
02/11/2011
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