Provider Demographics
NPI:1104939131
Name:DEVICK, DARREL (DO)
Entity type:Individual
Prefix:
First Name:DARREL
Middle Name:
Last Name:DEVICK
Suffix:
Gender:M
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:515-237-3985
Mailing Address - Fax:515-237-3994
Practice Address - Street 1:1540 HIGH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3106
Practice Address - Country:US
Practice Address - Phone:515-237-3985
Practice Address - Fax:515-237-3994
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-01557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA47536OtherWELLMARK
IA1155655Medicaid
IAA02922Medicare UPIN
IAI6298Medicare ID - Type Unspecified