Healthcare Provider Details

I. General information

NPI: 1336436831
Provider Name (Legal Business Name): AMY ELIZABETH REPPERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SAINT FRANCIS DR STE 410
WATERLOO IA
50702-5634
US

IV. Provider business mailing address

2101 KIMBALL AVE
WATERLOO IA
50702-5063
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-5000
  • Fax: 319-272-5264
Mailing address:
  • Phone: 319-272-1590
  • Fax: 319-272-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number43404
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: