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General NPI Number Information
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NPI Number | 1326305830
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Entity Type | Individual
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Provider Name | RYAN DEETS
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Gender | Male
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 1223 S GEAR AVE STE 202
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City | WEST BURLINGTON
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State | IA
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Zip | 52655
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Country | US
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Telephone | 319-768-4350
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 S GEAR AVE STE 202
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1679
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Country | US
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Telephone |
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Fax |
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | R-9657
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD-45213
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License Number State | IA
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