Provider Demographics
NPI:1780679316
Name:MOUW, BERNARD DEPREE (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:DEPREE
Last Name:MOUW
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 4907
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-4907
Mailing Address - Country:US
Mailing Address - Phone:515-875-9925
Mailing Address - Fax:515-875-9923
Practice Address - Street 1:5950 UNIVERSITY AVE
Practice Address - Street 2:STE 135
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8216
Practice Address - Country:US
Practice Address - Phone:515-875-9795
Practice Address - Fax:515-875-9796
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-11-20
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Provider Licenses
StateLicense IDTaxonomies
IA18763208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA01179Medicare UPIN