Healthcare Provider Details

I. General information

NPI: 1891763389
Provider Name (Legal Business Name): RONALD W DOSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 39TH AVE
AMANA IA
52203-8229
US

IV. Provider business mailing address

505 39TH AVE PO BOX 207
AMANA IA
52203-8229
US

V. Phone/Fax

Practice location:
  • Phone: 319-622-3231
  • Fax: 319-622-3077
Mailing address:
  • Phone: 319-622-3231
  • Fax: 319-622-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30764
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: