Provider Demographics
NPI:1912972688
Name:DVORAK, BRIAN ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ROBERT
Last Name:DVORAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BOYSON RD
Mailing Address - Street 2:SUITE #D3
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2211
Mailing Address - Country:US
Mailing Address - Phone:319-378-8280
Mailing Address - Fax:319-378-8260
Practice Address - Street 1:1350 BOYSON RD
Practice Address - Street 2:SUITE #D3
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2211
Practice Address - Country:US
Practice Address - Phone:319-378-8280
Practice Address - Fax:319-378-8260
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00774213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0449520Medicaid
V01938Medicare UPIN
IA0449520Medicaid
I14000Medicare PIN