Individual
JERRY WILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
402 SIEGEL ST, TAMA, IA 52339-2302
(641) 484-3333
(641) 484-3208
Mailing address
PO BOX 1824, CEDAR RAPIDS, IA 52406-1824
(319) 369-4505
(319) 369-4677
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21193
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4168401
—
IA
Enumeration date
03/10/2006
Last updated
10/25/2007
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