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General NPI Number Information
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NPI Number | 1215979919
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Entity Type | Organization
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Legal Business Name | THE GASTROENTEROLOGY CLINIC, PLC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 1223 S GEAR AVE SUITE 201
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1682
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Country | US
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Telephone | 319-758-9075
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Fax | 319-758-9079
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Provider Business Mailing Address
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Address Line | 1223 S GEAR AVE SUITE 201
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1682
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Country | US
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Telephone | 319-758-9075
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Fax | 319-758-9079
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DANIEL PEASLEY
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Credential | DO
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Telephone | 319-758-9075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 03066
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License Number State | IA
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