Provider Demographics
NPI:1164401949
Name:RILEY-BURT, JANICE R (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:R
Last Name:RILEY-BURT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2600
Mailing Address - Fax:515-241-2032
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2600
Practice Address - Fax:515-241-2032
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2233445Medicaid
IA0233445Medicaid
IA1233445Medicaid
IA1233445Medicaid
IA0233445Medicaid