Individual
DOUGLAS EARL VICKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2979 VICTORIA ST, VA OPT CLINIC, BETTENDORF, IA 52722
(563) 332-8528
(563) 332-9331
Mailing address
25665 VALLEY DRIVE, BETTENDORF, IA 52722-7315
(563) 332-4172
(563) 332-4172
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19440
IA
Other
Enumeration date
08/24/2006
Last updated
07/08/2007
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