Healthcare Provider Details

I. General information

NPI: 1821022161
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 53RD AVENUE
BETTENDORF IA
52753
US

IV. Provider business mailing address

2222 53RD AVENUE
BETTENDORF IA
52753
US

V. Phone/Fax

Practice location:
  • Phone: 563-383-2686
  • Fax: 563-884-8144
Mailing address:
  • Phone: 563-383-2686
  • Fax: 563-884-8144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERLING LARSON III
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 563-383-2686