Individual
JOSEPH M PHELAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1970 E 53RD ST, DAVENPORT, IA 52807-2710
(563) 359-3949
Mailing address
1970 E 53RD ST, DAVENPORT, IA 52807-2710
(563) 359-3949
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
28009
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04345
BCBS IA RGIC LLC
—
05
—
1072801
—
IA
01
—
32225
BCBS IA RGPCSC
—
05
—
6072801
—
IA
Enumeration date
03/28/2006
Last updated
07/09/2007
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