Individual
KENNETH S WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1005 PENNSYLVANIA AVE, SUITE 104, OTTUMWA, IA 52501-6413
(641) 682-4594
(641) 682-2123
Mailing address
1005 PENNSYLVANIA AVE, SUITE 104, OTTUMWA, IA 52501-6413
(641) 682-4594
(641) 682-2123
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
32349
IA
207RP1001X
Pulmonary Disease Physician
32349
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0169417
—
IA
01
—
110166527
RR MEDICARE
IA
05
—
1169417
—
IA
05
—
1174500151
—
IA
05
—
2169417
—
IA
Enumeration date
12/29/2005
Last updated
05/17/2012
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