Individual
MONY FRAER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-4409
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 356-4409
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
38318
IA
207R00000X
Internal Medicine Physician
E-4322
AR
207RN0300X
Nephrology Physician
Primary
38318
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05070021200
QUALCHOICE
AR
05
—
157995001
—
AR
01
—
5N167
BCBS
AR
01
—
P00266508
RAILROAD MEDICARE1
AR
Enumeration date
10/13/2006
Last updated
09/29/2009
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