Provider Demographics
NPI:1750334751
Name:REDFERN, DAVID CARTER (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CARTER
Last Name:REDFERN
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:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-833-5982
Mailing Address - Fax:319-833-5983
Practice Address - Street 1:1753 W RIDGEWAY AVE
Practice Address - Street 2:STE 106
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4588
Practice Address - Country:US
Practice Address - Phone:319-833-5982
Practice Address - Fax:319-833-5983
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30869207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42141730749OtherJOHN DEERE HEALTH CARE
IA52489OtherWELLMARK INS PLAN
IA0132373Medicaid
IA52489Medicare ID - Type Unspecified
IA0132373Medicaid