Provider Demographics
NPI:1700847787
Name:FASBENDER, PATRICIA ANN (DO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:FASBENDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 MERLE HAY RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1908
Mailing Address - Country:US
Mailing Address - Phone:515-278-0949
Mailing Address - Fax:515-278-6721
Practice Address - Street 1:4631 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1908
Practice Address - Country:US
Practice Address - Phone:515-278-0949
Practice Address - Fax:515-278-6721
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1700847787Medicaid
IA71926034Medicare PIN