Individual
MR. JACOB ANTHONY LORSUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2424 128TH ST, URBANDALE, IA 50323-1816
(515) 243-8676
Mailing address
811 FLETCHER AVE, WATERLOO, IA 50701-3041
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
099740
IA
Other
Enumeration date
01/22/2020
Last updated
01/22/2020
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