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1063529105
DOUGLAS EARL VICKSTROM
BETTENDORF, IA
NPI
1063529105
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207R00000X Internal Medicine
(Licence: IA 19440)
Enumeration Date
2006-08-24
Last Update Date
2007-07-08
Business Address
-- DOUGLAS EARL VICKSTROM MD
2979 VICTORIA ST VA OPT CLINIC
BETTENDORF, IA 52722
Phone number: 563-332-8528
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Mailing Address
-- DOUGLAS EARL VICKSTROM MD
25665 VALLEY DRIVE
BETTENDORF, IA 52722-7315
Phone number: 563-332-4172
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