Provider Demographics
NPI:1205808433
Name:WALD, MOSHE (MD)
Entity type:Individual
Prefix:
First Name:MOSHE
Middle Name:
Last Name:WALD
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2421
Mailing Address - Fax:319-356-3900
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2421
Practice Address - Fax:319-356-3900
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36306208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0446351Medicaid
IA37055OtherWELLMARK BCBS
I19351Medicare UPIN
IAI13337Medicare PIN
IA37055OtherWELLMARK BCBS