1205815297 NPI number — MR. DAVID SCOTT STUDER DO

Table of content: MR. DAVID SCOTT STUDER DO (NPI 1205815297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205815297 NPI number — MR. DAVID SCOTT STUDER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUDER
Provider First Name:
DAVID
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1205815297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1153 BURR OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-6622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-778-4956
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 S WHITE ST
Provider Second Line Business Practice Location Address:
HENRY COUNTY HEALTH CENTER
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52641-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-385-6153
Provider Business Practice Location Address Fax Number:
319-385-6599
Provider Enumeration Date:
01/10/2006

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: 207P00000X , with the licence number:  02060 , 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)