Provider Demographics
NPI:1336125483
Name:BEDIA, ENRIQUE R (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:R
Last Name:BEDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2200
Mailing Address - Fax:515-241-2201
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2200
Practice Address - Fax:515-241-2201
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA29229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA160041557OtherRR MEDICARE
IA01832541Medicaid
IA1336125483Medicaid
IA4183251Medicaid
G87940Medicare UPIN
IA48327Medicare PIN