Provider Demographics
NPI:1083787113
Name:MOATS, BARBARA K (DO)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:K
Last Name:MOATS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 I AVE
Mailing Address - Street 2:
Mailing Address - City:EARLHAM
Mailing Address - State:IA
Mailing Address - Zip Code:50072-8035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 PENNSYLVANIA AVE
Practice Address - Street 2:STE 417
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2350
Practice Address - Country:US
Practice Address - Phone:515-263-5684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01961207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1017210Medicaid
IA2017210Medicaid
IA1017210Medicaid
IA2017210Medicaid
IA54698Medicare ID - Type UnspecifiedILH