Provider Demographics
NPI:1194987016
Name:REPP, BETH R (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:R
Last Name:REPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:R
Other - Last Name:KUTZBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4731 45TH STREET CT
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7102
Mailing Address - Country:US
Mailing Address - Phone:309-793-2020
Mailing Address - Fax:309-793-2602
Practice Address - Street 1:777 TANGLEFOOT LN
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1650
Practice Address - Country:US
Practice Address - Phone:563-323-2020
Practice Address - Fax:563-328-5694
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50530207W00000X
IA39738207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35359500Medicaid
IAENROLLEDMedicaid
MNP00737845OtherRAILROAD MEDICARE
MNENROLLEDMedicaid
MN180001355Medicare PIN