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NPI Code Detail

MEDICARE: RYAN SCOTT BAKKE D.O.

MEDICARE: RYAN SCOTT BAKKE D.O.
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
1207Q00000XFamily Medicine Physician3471IA
2207P00000XEmergency Medicine Physician3471IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1546840006OTHERMEDICARE PTAN
3546830006OTHERIAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
435873OTHERIABCBS PROVIDER #

General Provider Information

NPI Number : 1225030406
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN SCOTT BAKKE D.O.
Provider Business Mailing Address
First Line : 204 N 4TH AVE E
Second Line :
City : NEWTON
State : IA
Zip : 50208-3135
Country : US
Telephone Number : 641-792-1273
Fax Number : 641-791-4852
Provider Business Practice Location Address
First Line : 204 N 4TH AVE E
Second Line :
City : NEWTON
State : IA
Zip : 50208-3135
Country : US
Telephone Number : 641-792-1273
Fax Number : 641-791-4852
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 11/19/2008

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Directions to “ RYAN SCOTT BAKKE D.O.” Practice Location

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