Provider Demographics
NPI:1578631826
Name:DEAY, CHARLES J (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:DEAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:411 LAUREL STREET
Mailing Address - Street 2:SUITE 3170
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314
Mailing Address - Country:US
Mailing Address - Phone:515-283-0463
Mailing Address - Fax:515-283-0794
Practice Address - Street 1:411 LAUREL STREET
Practice Address - Street 2:SUITE 3170
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314
Practice Address - Country:US
Practice Address - Phone:515-283-0463
Practice Address - Fax:515-283-0794
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA27486207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0064600Medicaid
IA00080Medicare ID - Type Unspecified
E67884Medicare UPIN