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Individual

DR. RENEE DIANE LASS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
4626 PROGRESS DR, SUITE B, DAVENPORT, IA 52807-3485
(563) 359-3736
(563) 359-0153
Mailing address
4626 PROGRESS DR, SUITE B, DAVENPORT, IA 52807-3485
(563) 359-3736
(563) 359-0153

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3589
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
04386
BLUE CROSS BLUE SHIELD
IA
05
3444885
IA
Enumeration date
03/28/2006
Last updated
07/21/2015
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