Provider Demographics
NPI:1528046117
Name:SUFKA-BOYD, PAMELA L (DO)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:L
Last Name:SUFKA-BOYD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7147 VISTA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-9313
Mailing Address - Country:US
Mailing Address - Phone:515-875-9925
Mailing Address - Fax:515-875-9923
Practice Address - Street 1:1410 SW TRADITION DR
Practice Address - Street 2:STE 120
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-875-9040
Practice Address - Fax:515-875-9041
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-02951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080106294OtherRR MEDICARE
IA1125054Medicaid
IA3125054Medicaid
IA1528046117Medicaid
IA2125054Medicaid
IA4125054Medicaid
IA1125054Medicaid
IA2125054Medicaid