Healthcare Provider Details

I. General information

NPI: 1861868234
Provider Name (Legal Business Name): BENJAMIN BAUDLER RDN, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S 4TH ST
CLINTON IA
52732-5726
US

IV. Provider business mailing address

901 S 4TH ST
CLINTON IA
52732-5726
US

V. Phone/Fax

Practice location:
  • Phone: 563-243-6162
  • Fax: 563-244-0903
Mailing address:
  • Phone: 563-243-6162
  • Fax: 563-244-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number079043
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: