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General NPI Number Information
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NPI Number | 1326157140
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Entity Type | Organization
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Legal Business Name | BURLINGTON EAR NOSE & THROAT CLINIC PC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 02/24/2015
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Provider Practice Location Address
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Address Line | 1225 S GEAR AVE STE 255
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1687
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Country | US
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Telephone | 319-752-2725
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Fax | 319-753-1084
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Provider Business Mailing Address
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Address Line | 1225 S GEAR AVE STE 255
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1687
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Country | US
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Telephone | 319-752-2725
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Fax | 319-753-1084
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. DOUGLAS EDWIN HENRICH
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Credential | M.D.
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Telephone | 319-752-2725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 31549 / 34553
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License Number State | IA
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