Provider Demographics
NPI:1427040930
Name:STEMMERMAN, LARAE GAIL (DO)
Entity Type:Individual
Prefix:MS
First Name:LARAE
Middle Name:GAIL
Last Name:STEMMERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-1108
Mailing Address - Country:US
Mailing Address - Phone:319-470-1536
Mailing Address - Fax:
Practice Address - Street 1:905 29TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-1138
Practice Address - Country:US
Practice Address - Phone:319-826-6374
Practice Address - Fax:319-826-6377
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2207654Medicaid