Individual
RYAN SCOTT BAKKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
204 N 4TH AVE E, NEWTON, IA 50208-3135
(641) 792-1273
(641) 791-4852
Mailing address
204 N 4TH AVE E, NEWTON, IA 50208-3135
(641) 792-1273
(641) 791-4852
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
3471
IA
207Q00000X
Family Medicine Physician
3471
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0422048
—
IA
01
—
35873
BCBS PROVIDER #
IA
01
—
546830006
MEDICARE PTAN
IA
01
—
546840006
MEDICARE PTAN
—
Enumeration date
06/01/2005
Last updated
11/19/2008
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