Basic Information
Provider Information | |||||||||
NPI: | 1821059510 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROWAN | ||||||||
FirstName: | BRIAN | ||||||||
MiddleName: | ANTHONY | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 300 PERSHING AVE | ||||||||
Address2: |   | ||||||||
City: | SHENANDOAH | ||||||||
State: | IA | ||||||||
PostalCode: | 516012355 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7122461230 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1 JACK FOSTER DR | ||||||||
Address2: |   | ||||||||
City: | SHENANDOAH | ||||||||
State: | IA | ||||||||
PostalCode: | 516014586 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7122467400 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/31/2006 | ||||||||
LastUpdateDate: | 03/13/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME83233 | FL | N |   | Other Service Providers | Specialist |   | 207X00000X | 053942 | GA | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207X00000X | 42901 | IA | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 6431065 | 01 | FL | CIGNA | OTHER | 428855242F | 05 | GA |   | MEDICAID | 263750200 | 05 | FL |   | MEDICAID | 7321304 | 01 | FL | AETNA | OTHER | 03353 | 01 | FL | BCBS | OTHER |