Individual
BETH R REPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
777 TANGLEFOOT LN, BETTENDORF, IA 52722-1650
(563) 323-2020
(563) 328-5694
Mailing address
4731 45TH STREET CT, ROCK ISLAND, IL 61201-7102
(309) 793-2020
(309) 793-2602
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
39738
IA
207W00000X
Ophthalmology Physician
50530
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35359500
—
WI
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
01
—
P00737845
RAILROAD MEDICARE
MN
Enumeration date
07/01/2008
Last updated
12/22/2015
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