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General NPI Number Information
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NPI Number | 1386654879
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Entity Type | Organization
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Legal Business Name | BASTUG PLASTIC SURGERY PC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 2710 SAINT FRANCIS DR SUITE 419
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City | WATERLOO
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State | IA
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Zip | 50702-5619
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Country | US
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Telephone | 319-272-8550
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Fax | 319-272-8558
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Provider Business Mailing Address
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Address Line | 2710 SAINT FRANCIS DR SUITE 419
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City | WATERLOO
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State | IA
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Zip | 50702-5634
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Country | US
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Telephone | 319-272-8550
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Fax | 319-272-8558
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENIZ F BASTUG
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Credential | MD
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Telephone | 319-272-8550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 32236
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License Number State | IA
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