Provider Demographics
NPI:1184675159
Name:VAUDT, CORY C (DO)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:C
Last Name:VAUDT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 NW ROCKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-6005
Mailing Address - Country:US
Mailing Address - Phone:515-965-8594
Mailing Address - Fax:
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:515-263-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008246207P00000X
IA3688207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1744979Medicaid
P00368423OtherRAILROAD MEDICARE
IA0744979Medicaid
OH2478466Medicaid
IA31677OtherWELLMARK OF IOWA
31683OtherWELLMARK OF IOWA
000000361694OtherBCBS
OH2478466Medicaid
IA0744979Medicaid
000000361694OtherBCBS
IAI19208Medicare PIN