Healthcare Provider Details

I. General information

NPI: 1831159193
Provider Name (Legal Business Name): DOUGLAS A. LAYTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S 3RD ST
POLK CITY IA
50226-1130
US

IV. Provider business mailing address

1010 S 3RD ST
POLK CITY IA
50226-1130
US

V. Phone/Fax

Practice location:
  • Phone: 515-984-6426
  • Fax:
Mailing address:
  • Phone: 515-984-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02723
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: