Individual
PACKY A HUETTMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3200 WEST KIMBERLY ROAD, SUITE 200, DAVENPORT, IA 52806
(563) 355-9191
(563) 355-3419
Mailing address
3200 WEST KIMBERLY ROAD, SUITE 200, DAVENPORT, IA 52806
(563) 355-9191
(563) 355-3419
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03132
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
066152
HEALTH ALLIANCE
—
05
—
2167544
—
IA
01
—
30409
WELLMARK BC/BS
—
01
—
4796890008
DMERC
—
01
—
67701
IOWA HEALTH SOLUTIONS
—
01
—
IA01D2
JOHN DEERE HEALTH PLAN
—
Enumeration date
06/20/2005
Last updated
06/29/2021
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