Provider Demographics
NPI:1073525010
Name:BARGMAN, LUAN M (PA)
Entity type:Individual
Prefix:
First Name:LUAN
Middle Name:M
Last Name:BARGMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LUAN
Other - Middle Name:
Other - Last Name:MONTAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-494-3041
Mailing Address - Fax:641-494-3059
Practice Address - Street 1:1010 4TH ST SW
Practice Address - Street 2:SUITE 120
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2857
Practice Address - Country:US
Practice Address - Phone:641-428-6020
Practice Address - Fax:641-428-7803
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001296363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23719OtherWELLMARK
IAP14651Medicare UPIN
IA23719OtherWELLMARK