Provider Demographics
NPI:1093700783
Name:LAW, IAN H (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:H
Last Name:LAW
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:319-356-4697
Mailing Address - Fax:319-356-4693
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:319-356-4697
Practice Address - Fax:319-356-4693
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA333082080P0202X
NV97092080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC8384OtherBLUE CROSS BLUE SHIELD
NV002018487Medicaid
IA0206789Medicaid
IA15264OtherWELLMARK BCBS
NV39552Medicare PIN
H10356Medicare UPIN
NV002018487Medicaid
IA060058548Medicare PIN