Basic Information
| Provider Information | |||||||||
| NPI: | 1609294305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DORNBIER | ||||||||
| FirstName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12129 UNIVERSITY AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154003550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12129 UNIVERSITY AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503258287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154003550 | ||||||||
| FaxNumber: | 5154003551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2014 | ||||||||
| LastUpdateDate: | 07/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 125.065964 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208800000X | 125.065964 | IL | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 036147483 | IL | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.