Basic Information
| Provider Information | |||||||||
| NPI: | 1568450849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORTH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 71602 | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503250602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152432057 | ||||||||
| FaxNumber: | 5152445570 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 CARBONADO RD | ||||||||
| Address2: | |||||||||
| City: | OSKALOOSA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525772424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416763366 | ||||||||
| FaxNumber: | 6416733366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 32784 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 71588 | 01 | IA | WELLMARK BCBS | OTHER | 1187377 | 05 | IA | MEDICAID | P00604766 | 01 | IA | RAILROAD MEDICARE | OTHER |