Provider Demographics
NPI:1306825922
Name:ROOF, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:ROOF
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 1:1030 5TH AVE SE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2464
Mailing Address - Country:US
Mailing Address - Phone:319-363-8121
Mailing Address - Fax:319-365-1396
Practice Address - Street 1:1030 5TH AVE SE
Practice Address - Street 2:SUITE 1400
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2464
Practice Address - Country:US
Practice Address - Phone:319-363-8121
Practice Address - Fax:319-365-1396
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3032052Medicaid
IA970003141OtherRR MEDICARE
IA4032052Medicaid
IA080078854OtherRR MEDICARE
IA2032052Medicaid
IA1306825922Medicaid
IA1306825922Medicaid
IA970003141OtherRR MEDICARE