Provider Demographics
NPI:1083804793
Name:BERMEL, HOLLEY A (DO)
Entity Type:Individual
Prefix:DR
First Name:HOLLEY
Middle Name:A
Last Name:BERMEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-1901
Mailing Address - Country:US
Mailing Address - Phone:515-262-0404
Mailing Address - Fax:515-262-0489
Practice Address - Street 1:2301 E 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-1901
Practice Address - Country:US
Practice Address - Phone:515-262-0404
Practice Address - Fax:515-262-0489
Is Sole Proprietor?:No
Enumeration Date:2007-07-29
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8458207Q00000X
IA4031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1083804793Medicaid
IA1083804793Medicaid