Individual
SCOTT P FACKRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6000 UNIVERSITY AVE, SUITE 101, WEST DES MOINES, IA 50266-8203
(515) 241-2600
(515) 241-2032
Mailing address
6000 UNIVERSITY AVE, SUITE 101, WEST DES MOINES, IA 50266-8203
(515) 241-2600
(515) 241-2032
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02977
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0130096
—
IA
05
—
1130096
—
IA
05
—
2130096
—
IA
Enumeration date
12/30/2005
Last updated
08/30/2012
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