Healthcare Provider Details

I. General information

NPI: 1386758613
Provider Name (Legal Business Name): ROY WILLIAM OVERTON III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5927 HIGHLAND CIR
WEST DES MOINES IA
50266-2825
US

IV. Provider business mailing address

5927 HIGHLAND CIR
WEST DES MOINES IA
50266-2825
US

V. Phone/Fax

Practice location:
  • Phone: 515-327-2089
  • Fax: 515-440-4599
Mailing address:
  • Phone: 515-208-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number02075
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberDO-2075
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: