Provider Demographics
NPI:1255310744
Name:ACKLAND, CANDYCE L (MD)
Entity Type:Individual
Prefix:
First Name:CANDYCE
Middle Name:L
Last Name:ACKLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3385 DEXTER CT STE 105
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3471
Mailing Address - Country:US
Mailing Address - Phone:563-551-3800
Mailing Address - Fax:563-551-3801
Practice Address - Street 1:3385 DEXTER CT STE 105
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-551-3801
Practice Address - Fax:563-551-3801
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA33758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G73047Medicare UPIN