1194930081 NPI number — DR. DAMON J. DYCHE M.D.

Table of content: EMILY GILBERT LCSW (NPI 1710359039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194930081 NPI number — DR. DAMON J. DYCHE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DYCHE
Provider First Name:
DAMON
Provider Middle Name:
J.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DYCHE
Provider Other First Name:
DAMON
Provider Other Middle Name:
JAMES
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194930081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3014
Provider Second Line Business Mailing Address:
1215 DUFF AVE., MCFARLAND CLINIC, PC
Provider Business Mailing Address City Name:
AMES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50010-3014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-239-4490
Provider Business Mailing Address Fax Number:
515-239-4771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 DUFF AVE.,
Provider Second Line Business Practice Location Address:
MCFARLAND CLINIC, PC
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50010-3014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-239-4490
Provider Business Practice Location Address Fax Number:
515-239-4771
Provider Enumeration Date:
05/14/2007

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: 208800000X , with the licence number:  4301085991 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 39529 , 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)





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