Provider Demographics
NPI:1932102639
Name:PAUL, JEAN (DO)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:DO
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-8100
Mailing Address - Fax:515-643-8139
Practice Address - Street 1:800 E. FIRST STREET
Practice Address - Street 2:SUITE 1700
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2100
Practice Address - Country:US
Practice Address - Phone:515-643-8100
Practice Address - Fax:515-643-8139
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031820OtherMEDICARE
AZ61788OtherMEDICARE
AZ031814OtherMEDICARE
Z64711Medicare PIN
H33047Medicare UPIN
AZ031815OtherMEDICARE
AZ031828OtherMEDICARE
AZ031813OtherMEDICARE