Provider Demographics
NPI:1083626063
Name:BELLING, WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:BELLING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3403 159TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2482
Mailing Address - Country:US
Mailing Address - Phone:515-528-6682
Mailing Address - Fax:
Practice Address - Street 1:3403 159TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323-2482
Practice Address - Country:US
Practice Address - Phone:515-528-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA9085167Medicaid
IAF35390Medicare UPIN
IA9085167Medicaid