Basic Information
| Provider Information | |||||||||
| NPI: | 1891868097 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | STRAIT | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 KIMBALL AVE | ||||||||
| Address2: | LL14 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192721590 | ||||||||
| FaxNumber: | 3192721535 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 HIGHWAY 218 N | ||||||||
| Address2: | |||||||||
| City: | LA PORTE CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506511012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193422131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3014 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7167247 | 05 | IA | MEDICAID |