=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841709060
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL THOMAS BARGER PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2017
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 53RD AVE STE 100
-----------------------------------------------------
City | BETTENDORF
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52722-7565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-322-0971
-----------------------------------------------------
Fax | 563-324-0615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 53RD AVE STE 100
-----------------------------------------------------
City | BETTENDORF
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52722-7565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-322-0971
-----------------------------------------------------
Fax | 563-324-0615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 088944
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------