Organization
AFFILIATES OF FAMILY PRACTICE OF CEDAR RAPIDS
Active
Other names
Affiliates of Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH ALBERT CEARLOCK MD (PARTNER OWNER)
(319) 364-7730
Entity
Organization
Contact information
Practice address
1030 5TH AVENUE SE, SUITE 1700, CEDAR RAPIDS, IA 52403
(319) 364-7730
(319) 364-0240
Mailing address
1030 5TH AVENUE SE, SUITE 1700, CEDAR RAPIDS, IA 52403
(319) 364-7730
(319) 364-0240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22198
IA
207Q00000X
Family Medicine Physician
34383
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0253740
—
IA
Enumeration date
08/21/2006
Last updated
08/22/2020
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