Provider Demographics
NPI:1043208648
Name:GOEKEN, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:GOEKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-1966
Mailing Address - Fax:319-384-8053
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-1966
Practice Address - Fax:319-384-8053
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19093207ZI0100X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0224386Medicaid
IA22438OtherWELLMARK BCBS
IA33935OtherWELLMARK BCBS
IA1224386Medicaid
IAP00050274Medicare PIN
IA0224386Medicaid
IAI9681Medicare PIN
A02616Medicare UPIN