Provider Demographics
NPI:1437138385
Name:OPHEIM, ERIC F (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:F
Last Name:OPHEIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-2046
Mailing Address - Country:US
Mailing Address - Phone:319-824-6945
Mailing Address - Fax:319-824-6947
Practice Address - Street 1:606 E 1ST ST
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-2046
Practice Address - Country:US
Practice Address - Phone:319-824-6945
Practice Address - Fax:319-824-6947
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5239582Medicaid
IA4239582Medicaid
IAP00174839OtherRR MEDICARE
IA4239582Medicaid
IAH70192Medicare UPIN