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Individual

JIMMY R. MASCARO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
312 E ALTA VISTA AVE, OTTUMWA, IA 52501-1413
(641) 683-4454
(641) 683-4450
Mailing address
312 E ALTA VISTA AVE, OTTUMWA, IA 52501-1413
(641) 683-4454
(641) 683-4450

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
3768
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0739672
IA
01
28586
BCBS
IA
01
28587
BCBS OTHER
IA
01
IA01J4
UHC
IA
Enumeration date
11/14/2006
Last updated
10/16/2007
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