Provider Demographics
NPI:1831159193
Name:LAYTON, DOUGLAS A (DO)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:LAYTON
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 1:1010 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-1130
Mailing Address - Country:US
Mailing Address - Phone:515-984-6426
Mailing Address - Fax:
Practice Address - Street 1:1010 S 3RD ST
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-1130
Practice Address - Country:US
Practice Address - Phone:515-984-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6073155Medicaid
IA1831159193Medicaid
IA6073155Medicaid
IA719260353Medicare PIN
IA080059780Medicare PIN
IA1831159193Medicaid