Provider Demographics
NPI:1770548570
Name:SANDS, BRYAN DAVID (DO)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DAVID
Last Name:SANDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3812 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5200
Mailing Address - Country:US
Mailing Address - Phone:319-236-3444
Mailing Address - Fax:319-236-0257
Practice Address - Street 1:3812 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5200
Practice Address - Country:US
Practice Address - Phone:319-236-3444
Practice Address - Fax:319-236-0257
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02896207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA070010603OtherRR MDCR
IA0151738Medicaid
IA0151738Medicaid
G21779Medicare UPIN