Provider Demographics
NPI:1881823052
Name:BOGASON, EINAR (MD)
Entity Type:Individual
Prefix:
First Name:EINAR
Middle Name:
Last Name:BOGASON
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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-358-0100
Mailing Address - Fax:515-358-0109
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:EAST TOWER, SUITE B1
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2613
Practice Address - Country:US
Practice Address - Phone:515-358-0100
Practice Address - Fax:515-358-0109
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-43077207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery