Provider Demographics
NPI:1710079322
Name:NASSTROM, JEFFREY D (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:NASSTROM
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 1:620 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461-1456
Mailing Address - Country:US
Mailing Address - Phone:641-732-6100
Mailing Address - Fax:641-732-6108
Practice Address - Street 1:620 N 8TH ST
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-1456
Practice Address - Country:US
Practice Address - Phone:641-732-6100
Practice Address - Fax:641-732-6108
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16520OtherWELLMARK
IA1196485Medicaid
IA1196485Medicaid
IA16520Medicare ID - Type Unspecified