Healthcare Provider Details

I. General information

NPI: 1013097856
Provider Name (Legal Business Name): DUSTAFF R.C. PERSAUD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 OAKVIEW DR STE C
MUSCATINE IA
52761-5807
US

IV. Provider business mailing address

3500 OAKVIEW DR STE C
MUSCATINE IA
52761-5807
US

V. Phone/Fax

Practice location:
  • Phone: 563-554-2848
  • Fax: 563-726-7491
Mailing address:
  • Phone: 563-554-2848
  • Fax: 563-726-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number072087
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number007232
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: