Provider Demographics
NPI:1649439175
Name:CLOOS, CARLA ROSE (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ROSE
Last Name:CLOOS
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 1:301 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1113
Mailing Address - Country:US
Mailing Address - Phone:635-421-9900
Mailing Address - Fax:563-421-9929
Practice Address - Street 1:301 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1113
Practice Address - Country:US
Practice Address - Phone:563-421-9900
Practice Address - Fax:563-421-9929
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-R-8358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine