Provider Demographics
NPI:1356382923
Name:SPRINGER, CARLA J (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:J
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1015 S HACKETT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3500
Mailing Address - Country:US
Mailing Address - Phone:319-374-1000
Mailing Address - Fax:319-292-6526
Practice Address - Street 1:1015 S HACKETT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3500
Practice Address - Country:US
Practice Address - Phone:319-274-1000
Practice Address - Fax:319-292-6526
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR7503207Q00000X
IA37633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469924Medicaid
IA1356382923Medicaid
IAP00819893OtherRR MEDICARE
IAIB1491008Medicare PIN
IA719260111Medicare PIN