Healthcare Provider Details

I. General information

NPI: 1801883186
Provider Name (Legal Business Name): RICHARD A. BEDONT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 6TH AVE
DES MOINES IA
50314-2613
US

IV. Provider business mailing address

1111 6TH AVE
DES MOINES IA
50314-2613
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-2667
  • Fax: 515-643-2978
Mailing address:
  • Phone: 515-643-2667
  • Fax: 515-643-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number25920
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: