Basic Information
| Provider Information | |||||||||
| NPI: | 1225279136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENZEL | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12368 STRATFORD DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159610453 | ||||||||
| FaxNumber: | 5159612714 | ||||||||
| Practice Location | |||||||||
| Address1: | 12368 STRATFORD DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159610453 | ||||||||
| FaxNumber: | 5159612714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2009 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 258603 | MA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | DO-04692 | IA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.