Provider Demographics
NPI:1841287604
Name:STOCKDALE, COLLEEN K (MD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:K
Last Name:STOCKDALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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:319-384-6849
Mailing Address - Fax:319-356-3901
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:319-384-6849
Practice Address - Fax:319-356-3901
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31733207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0258756Medicaid
IA44919OtherWELLMARK BCBS
IA44919OtherWELLMARK BCBS
IA0258756Medicaid
IAI5761Medicare PIN