Provider Demographics
NPI:1538321971
Name:BANCROFT, SARAH A (DO)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:A
Last Name:BANCROFT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:KRISMANITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1215 DUFF AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-3410
Mailing Address - Fax:515-817-1237
Practice Address - Street 1:3500 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 1001
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010
Practice Address - Country:US
Practice Address - Phone:515-239-3410
Practice Address - Fax:515-817-1237
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04989207QS0010X
MI5101017596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201162230Medicaid
IN151020015OtherMEDICARE PTAN