Provider Demographics
NPI:1568450849
Name:NORTH, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:NORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71602
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-0602
Mailing Address - Country:US
Mailing Address - Phone:515-243-2057
Mailing Address - Fax:515-244-5570
Practice Address - Street 1:1910 CARBONADO RD
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2424
Practice Address - Country:US
Practice Address - Phone:641-676-3366
Practice Address - Fax:641-673-3366
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA71588OtherWELLMARK BCBS
IA1187377Medicaid
IAP00604766OtherRAILROAD MEDICARE
IA1187377Medicaid
IAIB1005Medicare PIN