Provider Demographics
NPI:1962507277
Name:SELOVER, DOUGLAS E (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:SELOVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4925
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-4925
Mailing Address - Country:US
Mailing Address - Phone:515-247-3292
Mailing Address - Fax:515-643-8933
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:PEDIATRIC EMERGENCY DEPT
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2613
Practice Address - Country:US
Practice Address - Phone:515-247-3211
Practice Address - Fax:515-643-8933
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2782208000000X, 208M00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4110247Medicaid
IA33642OtherWELLMARK
IA33642OtherWELLMARK
IAI8440Medicare ID - Type Unspecified