Provider Demographics
NPI:1548209919
Name:LEIDAL, REBECCA R (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:LEIDAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:R
Other - Last Name:SCHMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:2 BOYD TOWER
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1007
Mailing Address - Country:US
Mailing Address - Phone:319-356-4646
Mailing Address - Fax:319-356-4644
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:2 BOYD TOWER
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1007
Practice Address - Country:US
Practice Address - Phone:319-356-4646
Practice Address - Fax:319-356-4644
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0036871Medicaid
IA080064273OtherRAILROAD MEDICARE
IA0036871Medicaid
IA28138Medicare PIN