Individual
GREG EVAN RAECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1731 W RIDGEWAY AVE, STE 101, WATERLOO, IA 50701-4591
(319) 833-6001
(319) 833-6003
Mailing address
PO BOX 2758, WATERLOO, IA 50704-2758
(319) 833-6001
(319) 833-6003
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
02087
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42141730793
JOHN DEERE HLTH INS PLAN
IA
05
—
5030635
—
IA
01
—
56258
WELLMARK INS PLAN
IA
Enumeration date
06/03/2006
Last updated
09/07/2007
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