Provider Demographics
NPI:1942274626
Name:GUCFA, CORNELIUS JASON (MD)
Entity Type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:JASON
Last Name:GUCFA
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 1:6600 WESTOWN PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7707
Mailing Address - Country:US
Mailing Address - Phone:515-283-1221
Mailing Address - Fax:515-283-2017
Practice Address - Street 1:6600 WESTOWN PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7707
Practice Address - Country:US
Practice Address - Phone:515-283-1221
Practice Address - Fax:515-283-2017
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-344402084P0800X
WI451552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34467000Medicaid
IA1942274626Medicaid
WIH85138Medicare UPIN
IA719260458Medicare PIN
WI34467000Medicaid