Individual
KELLY SCOTT BAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2901 86TH ST, URBANDALE, IA 50322-4201
(515) 276-3406
(515) 276-5141
Mailing address
2901 86TH ST, URBANDALE, IA 50322-4201
(515) 276-3406
(515) 276-5141
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21562
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0161364
—
IA
Enumeration date
03/24/2006
Last updated
07/08/2007
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