Provider Demographics
NPI:1588650956
Name:BEDELL, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BEDELL
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-467-8355
Mailing Address - Fax:319-467-8351
Practice Address - Street 1:3056 RIVER CROSSING COURT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IA
Practice Address - Zip Code:52327-4727
Practice Address - Country:US
Practice Address - Phone:319-467-8355
Practice Address - Fax:319-467-8351
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29815207Q00000X
IAMD-29815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080164222OtherRR MEDICARE
IA1113605Medicaid
IA6113605Medicaid
IA1113605Medicaid
IA6113605Medicaid
IAI1410Medicare PIN