Basic Information
Provider Information
NPI: 1003299702
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLUG
FirstName: RYAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9943 HICKMAN RD
Address2: #105
City: DES MOINES
State: IA
PostalCode: 503225304
CountryCode: US
TelephoneNumber: 5152481447
FaxNumber: 5152481440
Practice Location
Address1: 2353 SE 14TH ST
Address2:  
City: DES MOINES
State: IA
PostalCode: 503201109
CountryCode: US
TelephoneNumber: 5152481400
FaxNumber: 5152481414
Other Information
ProviderEnumerationDate: 06/30/2015
LastUpdateDate: 07/23/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XA126297IAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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