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General NPI Number Information
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NPI Number | 1225030406
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Entity Type | Individual
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Provider Name | RYAN SCOTT BAKKE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 204 N 4TH AVE E
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City | NEWTON
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State | IA
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Zip | 50208-3135
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Country | US
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Telephone | 641-792-1273
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Fax | 641-791-4852
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Provider Business Mailing Address
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Address Line | 204 N 4TH AVE E
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City | NEWTON
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State | IA
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Zip | 50208-3135
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Country | US
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Telephone | 641-792-1273
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Fax | 641-791-4852
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3471
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 3471
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License Number State | IA
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