Active NPI
Bastug Plastic Surgery PC
- Specialist
- Waterloo, IA
National Provider Identifier
1386654879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 32236
- Legal business name
- BASTUG PLASTIC SURGERY PC
- Practice address
- 2710 Saint Francis Dr
Suite 419
Waterloo, IA 50702-5619 - Phone
- (319) 272-8550
- Fax
- (319) 272-8558
- NPI assigned
- Aug 8, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Deniz F Bastug, MD
- Title
- President
- Phone
- (319) 272-8550
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 32236 | IA | Primary |
Addresses
Primary practice location
2710 Saint Francis Dr
Suite 419
Waterloo, IA 50702-5619
Mailing address
2710 Saint Francis Dr
Suite 419
Waterloo, IA 50702-5634
Phone (319) 272-8550
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1162420 | Medicaid | IA | |
| 32236 | Other | IA | MEDICAL LICENSE |
| 249985 | Other | IA | MIDLAND'S CHOICE |
| IA0101 | Other | IA | JOHN DEERE HEALTH CARE |
| 41756 | Other | IA | WELLMARK |
Other names 1
- Renaissance Plastic Surgery Center
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1318550400000",
"number": "1386654879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2710 SAINT FRANCIS DR",
"address_2": "SUITE 419",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507025634",
"telephone_number": "319-272-8550",
"fax_number": "319-272-8558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2710 SAINT FRANCIS DR",
"address_2": "SUITE 419",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507025619",
"telephone_number": "319-272-8550",
"fax_number": "319-272-8558"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BASTUG PLASTIC SURGERY PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-08",
"last_updated": "2011-10-14",
"status": "A",
"authorized_official_last_name": "BASTUG",
"authorized_official_first_name": "DENIZ",
"authorized_official_middle_name": "F",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "319-272-8550",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "IA",
"license": "32236",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1162420",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "32236",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLAND'S CHOICE",
"identifier": "249985",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE HEALTH CARE",
"identifier": "IA0101",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK",
"identifier": "41756",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Renaissance Plastic Surgery Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Waterloo, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.