Provider Demographics
NPI:1770659591
Name:TAEGER, VINCENT A (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:TAEGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1645
Mailing Address - Country:US
Mailing Address - Phone:319-754-4242
Mailing Address - Fax:319-754-4079
Practice Address - Street 1:1201 W AGENCY RD
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1645
Practice Address - Country:US
Practice Address - Phone:319-754-4242
Practice Address - Fax:319-754-4079
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2417899Medicaid
IAI2241Medicare PIN
IAH97111Medicare UPIN