Douglas Earl Vickstrom MD

NPI 1063529105 - Internal Medicine - 207R00000X

NPI Details
NPI 1063529105
Gender Male
Enumeration Date 08/24/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
2979 VICTORIA ST
VA OPT CLINIC
BETTENDORF IA, 52722, US
Phone (563) 332-8528
Fax (563) 332-9331
Business Location
25665 VALLEY DRIVE
BETTENDORF IA, 52722-7315, US
Phone (563) 332-4172
Fax (563) 332-4172
Toxanomy
Taxonomy Code 207R00000X
License State Iowa
License Number 19440
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According to our database, Douglas Earl Vickstrom MD NPI is 1063529105, taxonomy code is 207R00000X and license number is 19440, license state is located at Iowa. Douglas Earl Vickstrom MD physically located at 2979 Victoria St, Bettendorf IA, 52722. NPI Number Douglas Earl Vickstrom MD has the Individual type.

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1063529105 NPI number is provided on an as is basis without warranty of any kind. 1063529105 is maintained by the National Plan & Provider Enumeration System. The contents of Douglas Earl Vickstrom MD are for informational purposes only.