=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194779736
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GENE STEBBINS GESSNER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 09/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 4TH AVE
-----------------------------------------------------
City | GRINNELL
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50112-1898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-236-2338
-----------------------------------------------------
Fax | 641-236-2427
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2400
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50704-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-232-6000
-----------------------------------------------------
Fax | 319-232-0722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 28333
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 28333
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------