Healthcare Provider Details

I. General information

NPI: 1245436765
Provider Name (Legal Business Name): RENE MARIE DUREGGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S CRESCENT DR
MASON CITY IA
50401-2926
US

IV. Provider business mailing address

250 S CRESCENT DR
MASON CITY IA
50401-2926
US

V. Phone/Fax

Practice location:
  • Phone: 641-494-5170
  • Fax:
Mailing address:
  • Phone: 641-494-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2014039231
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number39740
License Number StateIA

VII. Legacy identifiers

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

# 1
Identifier1245436765
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI
# 2
Identifier1245436765
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 3
Identifier1245436765
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: