1417940081 NPI number — RICHARD STANGLER MD

Table of content: RICHARD STANGLER MD (NPI 1417940081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417940081 NPI number — RICHARD STANGLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANGLER
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417940081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
03/30/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1136 H AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52402-4624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-362-9855
Provider Business Mailing Address Fax Number:
319-362-0655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1136 H AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52402-4624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-362-9855
Provider Business Practice Location Address Fax Number:
319-362-0655
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  33112 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0196980 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC8734 . This is a "RAILRAOD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07591 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 5265807 . This is a "AETNA KOEKWELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04855 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 42137562808 . This is a "JOHN DEERE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com