Provider Demographics
NPI:1134188683
Name:STUDER, SALLY JO (DO)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:JO
Last Name:STUDER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:6010 MILLS CIVIC PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8345
Mailing Address - Country:US
Mailing Address - Phone:515-224-9666
Mailing Address - Fax:515-224-5913
Practice Address - Street 1:6010 MILLS CIVIC PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8345
Practice Address - Country:US
Practice Address - Phone:515-224-9666
Practice Address - Fax:515-224-5913
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA02736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3073593Medicaid
IA1134188683Medicaid
IA16087Medicare PIN
IA1134188683Medicaid
IA080063101Medicare PIN
IAF46613Medicare UPIN