Healthcare Provider Details

I. General information

NPI: 1265880454
Provider Name (Legal Business Name): TYLER PAUL RASMUSSEN M.D./PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 10TH ST SE STE 225
CEDAR RAPIDS IA
52403-2419
US

IV. Provider business mailing address

202 10TH ST SE STE 225
CEDAR RAPIDS IA
52403-2419
US

V. Phone/Fax

Practice location:
  • Phone: 319-364-7101
  • Fax: 319-363-1993
Mailing address:
  • Phone: 319-364-7101
  • Fax: 319-363-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD-45723
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: