Provider Demographics
NPI:1780664805
Name:PECHOUS, BRYAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:PAUL
Last Name:PECHOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 NORTH GRANDVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6397
Mailing Address - Country:US
Mailing Address - Phone:563-588-4675
Mailing Address - Fax:563-588-1195
Practice Address - Street 1:300 NORTH GRANDVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6397
Practice Address - Country:US
Practice Address - Phone:563-588-4675
Practice Address - Fax:563-588-1195
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26857207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0055517Medicaid
IA0055517Medicaid
IAB62124Medicare UPIN