Healthcare Provider Details

I. General information

NPI: 1740268911
Provider Name (Legal Business Name): ROBERT M NATHANSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 SE 14TH ST
DES MOINES IA
50320-1109
US

IV. Provider business mailing address

9943 HICKMAN RD SUITE 105
URBANDALE IA
50322-5304
US

V. Phone/Fax

Practice location:
  • Phone: 515-248-1400
  • Fax: 515-248-1414
Mailing address:
  • Phone: 515-248-1447
  • Fax: 515-248-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02284
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: