Provider Demographics
NPI:1013097856
Name:PERSAUD, DUSTAFF RC (PA-C)
Entity type:Individual
Prefix:DR
First Name:DUSTAFF
Middle Name:RC
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 OAKVIEW DR STE C
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5807
Mailing Address - Country:US
Mailing Address - Phone:563-554-2848
Mailing Address - Fax:563-726-7491
Practice Address - Street 1:3500 OAKVIEW DR STE C
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5807
Practice Address - Country:US
Practice Address - Phone:563-554-2848
Practice Address - Fax:563-726-7491
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007232363AM0700X
IA072087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical