Basic Information
Provider Information | |||||||||
NPI: | 1932186962 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RASMUS | ||||||||
FirstName: | STEPHEN | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1351 W CENTRAL PARK AVE | ||||||||
Address2: | SUITE 3300 | ||||||||
City: | DAVENPORT | ||||||||
State: | IA | ||||||||
PostalCode: | 528041889 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5633832667 | ||||||||
FaxNumber: | 5633832672 | ||||||||
Practice Location | |||||||||
Address1: | 1351 W CENTRAL PARK AVE | ||||||||
Address2: | SUITE 3300 | ||||||||
City: | DAVENPORT | ||||||||
State: | IA | ||||||||
PostalCode: | 528041889 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5633832667 | ||||||||
FaxNumber: | 5633832672 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/30/2005 | ||||||||
LastUpdateDate: | 09/29/2011 | ||||||||
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 | 2084N0400X | 22893 | IA | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
ID | Type | State | Issuer | Description | A64003 | 01 |   | JOHN DEERE HEALTHCARE | OTHER | 21900 | 01 |   | WELLMARK | OTHER | 0196907 | 05 | IA |   | MEDICAID | 1764535 | 01 |   | UNITED HEALTHCARE | OTHER | 130005147 | 01 |   | RAILROAD MEDICARE | OTHER |