Provider Demographics
NPI:1861474421
Name:BUETTNER, MARK FRANCIS (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:FRANCIS
Last Name:BUETTNER
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 1:2701 17TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5351
Mailing Address - Country:US
Mailing Address - Phone:309-779-5000
Mailing Address - Fax:319-768-3633
Practice Address - Street 1:1000 W LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-1685
Practice Address - Country:US
Practice Address - Phone:515-386-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03231207P00000X, 207PE0005X
IADO-03231207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
36713OtherBX
IA930097504OtherRR MC
IA0189134Medicaid
IA49896OtherBX
IA0189134Medicaid
IA49896Medicare ID - Type Unspecified
36713OtherBX
IAP00731537Medicare PIN