Provider Demographics
NPI:1538156138
Name:TWYNER, LAFAYETTE J (MD)
Entity type:Individual
Prefix:MR
First Name:LAFAYETTE
Middle Name:J
Last Name:TWYNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 1ST AVE E STE D
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-4255
Mailing Address - Country:US
Mailing Address - Phone:641-787-0343
Mailing Address - Fax:641-787-0353
Practice Address - Street 1:2501 1ST AVE E STE D
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-4255
Practice Address - Country:US
Practice Address - Phone:641-787-0343
Practice Address - Fax:641-787-0353
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
42452OtherBC BS
IA2134551Medicaid
A01191Medicare UPIN
IA2134551Medicaid