=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851578868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RHEUMATOLOGY ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2008
-----------------------------------------------------
Last Update Date | 09/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3740 UTICA RIDGE RD
-----------------------------------------------------
City | BETTENDORF
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52722-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-359-4440
-----------------------------------------------------
Fax | 563-359-4644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3740 UTICA RIDGE RD
-----------------------------------------------------
City | BETTENDORF
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52722-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-359-4440
-----------------------------------------------------
Fax | 563-359-4644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DAVID B. STAUB
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 563-359-4440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 27098
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------