MEDICARE: DR. JASON J DEUTMEYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	34035	IA
2	208600000X	Surgery Physician	036104564	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01205760	OTHER	IA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	IA01X2	OTHER	JOHN DEERE
4	38078	OTHER	BCWELLMARK
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104899095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON J DEUTMEYER MD

Provider Business Mailing Address
First Line	:	4480 UTICA RIDGE ROAD
Second Line	:	SUITE 1124
City	:	BETTENDORF
State	:	IA
Zip	:	52722-1626
Country	:	US
Telephone Number	:	563-742-5300
Fax Number	:	563-742-5305

Provider Business Practice Location Address
First Line	:	4480 UTICA RIDGE RD
Second Line	:	SUITE 1124
City	:	BETTENDORF
State	:	IA
Zip	:	52722-1656
Country	:	US
Telephone Number	:	563-742-5300
Fax Number	:	563-742-5305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	02/05/2015

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Directions to “ DR. JASON J DEUTMEYER MD” Practice Location

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