Provider Demographics
NPI:1295747624
Name:MERY, GISELLE (MD)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:MERY
Suffix:
Gender:F
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:
Mailing Address - Fax:
Practice Address - Street 1:411 LAUREL ST STE A300
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3030
Practice Address - Country:US
Practice Address - Phone:515-282-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM54084207R00000X, 207RH0000X, 207RX0202X
IAMD-50497207R00000X, 207RX0202X
FLME120661207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012854500Medicaid
FLME120661OtherFL LICENSE
MD380170500Medicaid
MDD0059244OtherMEDICAL LICENSE
IA0095828Medicaid
MDD0059244OtherMEDICAL LICENSE
FLME120661OtherFL LICENSE