Provider Demographics
NPI:1104899095
Name:DEUTMEYER, JASON J (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:J
Last Name:DEUTMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4480 UTICA RIDGE ROAD
Mailing Address - Street 2:SUITE 1124
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1626
Mailing Address - Country:US
Mailing Address - Phone:563-742-5300
Mailing Address - Fax:563-742-5305
Practice Address - Street 1:4480 UTICA RIDGE RD
Practice Address - Street 2:SUITE 1124
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1656
Practice Address - Country:US
Practice Address - Phone:563-742-5300
Practice Address - Fax:563-742-5305
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34035208600000X
IL036104564208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA036104564Medicaid
IA1104899095Medicaid
IA01X2OtherJOHN DEERE
38078OtherBCWELLMARK
IAP01205760OtherRR MEDICARE
IA1240812Medicaid
IA036104564Medicaid
IAP01205760OtherRR MEDICARE