Provider Demographics
NPI:1326046079
Name:OB-GYN SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:OB-GYN SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-234-5764
Mailing Address - Street 1:432 KING DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5956
Mailing Address - Country:US
Mailing Address - Phone:319-234-5764
Mailing Address - Fax:319-234-1336
Practice Address - Street 1:432 KING DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5956
Practice Address - Country:US
Practice Address - Phone:319-234-5764
Practice Address - Fax:319-234-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0184473Medicaid
CP8715OtherRAILROAD MEDICARE
26933OtherBC/BS GROUP NUMBER
IA0184473Medicaid