Provider Demographics
NPI:1073594768
Name:FLATT, JERROLD VERLIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:VERLIN
Last Name:FLATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1301 PENN AVE
Mailing Address - Street 2:SUITE #316
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2350
Mailing Address - Country:US
Mailing Address - Phone:515-262-0996
Mailing Address - Fax:515-264-1009
Practice Address - Street 1:1301 PENN AVE
Practice Address - Street 2:SUITE #316
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2350
Practice Address - Country:US
Practice Address - Phone:515-262-0996
Practice Address - Fax:515-264-1009
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2009-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA01819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0170803Medicaid
IA10209Medicare PIN
IA0170803Medicaid