Individual
ASHOK R PENMATCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1230 E RUSHOLME ST, STE 203, DAVENPORT, IA 52803-2400
(563) 322-0923
(563) 322-7403
Mailing address
1230 E RUSHOLME ST, STE 203, DAVENPORT, IA 52803-2400
(563) 322-0923
(563) 322-7403
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
31845
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0156885
—
IA
01
—
59311
WELLMARK BCBS
IA
Enumeration date
02/01/2006
Last updated
06/30/2010
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