Provider Demographics
NPI:1639225311
Name:SHRIVER, AMY E (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:SHRIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 PLEASANT ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1453
Mailing Address - Country:US
Mailing Address - Phone:515-241-6000
Mailing Address - Fax:515-241-8728
Practice Address - Street 1:1212 PLEASANT ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1453
Practice Address - Country:US
Practice Address - Phone:515-241-6000
Practice Address - Fax:515-241-8728
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA39060208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1639225311Medicaid
175150027OtherMEDICARE
IA1639225311Medicaid
175150027OtherMEDICARE