Provider Demographics
NPI:1255303400
Name:KERMODE, DAVID SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:KERMODE
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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-6400
Mailing Address - Fax:515-643-5816
Practice Address - Street 1:411 LAUREL ST STE 3300
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3027
Practice Address - Country:US
Practice Address - Phone:515-643-6400
Practice Address - Fax:515-643-5816
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4H42208600000X
IA02888208600000X
IADO-02888208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA72045OtherBLUECROSS BLUE SHIELD - IOWA
MO906555OtherHEALTHLINK
MO158283OtherANTHEM BLUE CROSS BLUE SHIELD MISSOURI
MO332355706Medicare PIN
IA72045OtherBLUECROSS BLUE SHIELD - IOWA
IAI17380001Medicare PIN