Provider Demographics
NPI:1144329996
Name:ACOSTA, JUAN A (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:A
Other - Last Name:ACOSTA-GUILLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1215 DUFF AVENUE
Mailing Address - Street 2:MCFARLAND CLINIC PC
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4418
Mailing Address - Fax:515-239-4446
Practice Address - Street 1:1015 DUFF AVENUE
Practice Address - Street 2:MCFARLAND CLINIC PC
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-4435
Practice Address - Fax:515-239-4758
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2133252084N0400X
IA382492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAPTAN04961028Medicare PIN