Healthcare Provider Details

I. General information

NPI: 1164640041
Provider Name (Legal Business Name): BRYAN P NAVARETTE M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 4TH ST SW STE 100
MASON CITY IA
50401-2856
US

IV. Provider business mailing address

1010 4TH ST SW STE 100
MASON CITY IA
50401-2856
US

V. Phone/Fax

Practice location:
  • Phone: 641-424-0102
  • Fax:
Mailing address:
  • Phone: 641-424-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14939
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number40105
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: