Provider Demographics
NPI:1831129634
Name:BEDYNEK, GREGORY (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BEDYNEK
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 1:2710 SAINT FRANCIS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5664
Mailing Address - Country:US
Mailing Address - Phone:319-272-5000
Mailing Address - Fax:319-272-6775
Practice Address - Street 1:2710 SAINT FRANCIS DR STE 110
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5664
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:319-272-6775
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005034466207T00000X
IADO-05563207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204446900Medicaid
KS200369700AMedicaid
MOP00317215OtherRR MEDICARE
MO701E452Medicare PIN