Healthcare Provider Details

I. General information

NPI: 1952968380
Provider Name (Legal Business Name): AARON DYSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 06/23/2023
Certification Date: 05/16/2023
Deactivation Date: 03/28/2023
Reactivation Date: 05/10/2023

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

755 COMMUNITY DR APT 402
NORTH LIBERTY IA
52317-6715
US

V. Phone/Fax

Practice location:
  • Phone: 319-400-7300
  • Fax:
Mailing address:
  • Phone: 562-522-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR-12987
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: