Provider Demographics
NPI:1174726962
Name:WAHL, JEFFREY ROBERT (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROBERT
Last Name:WAHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1000 W LINCOLNWAY ST
Practice Address - Street 2:SUITE WCO
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-1645
Practice Address - Country:US
Practice Address - Phone:515-386-2240
Practice Address - Fax:515-386-2280
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA04092207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery