Basic Information
Provider Information | |||||||||
NPI: | 1396723284 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FLUGRAD | ||||||||
FirstName: | SHERRI | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CLEWELL | ||||||||
OtherFirstName: | SHERI | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DO | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3014 | ||||||||
Address2: | 1215 DUFF AVENUE | ||||||||
City: | AMES | ||||||||
State: | IA | ||||||||
PostalCode: | 500103014 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5152392155 | ||||||||
FaxNumber: | 5152392050 | ||||||||
Practice Location | |||||||||
Address1: | 1111 DUFF AVENUE | ||||||||
Address2: |   | ||||||||
City: | AMES | ||||||||
State: | IA | ||||||||
PostalCode: | 50010 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5152392155 | ||||||||
FaxNumber: | 5152392050 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/03/2006 | ||||||||
LastUpdateDate: | 12/21/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 3659 | IA | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 0474007 | 05 | IA |   | MEDICAID |