1699775981 NPI number — CRAIG L SEMLER OD

Table of content: CRAIG L SEMLER OD (NPI 1699775981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699775981 NPI number — CRAIG L SEMLER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEMLER
Provider First Name:
CRAIG
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699775981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 12TH AVE NE
Provider Second Line Business Mailing Address:
PO BOX 89
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50441-0089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-456-4251
Provider Business Mailing Address Fax Number:
641-456-3612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 12TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50441-0089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-456-4251
Provider Business Practice Location Address Fax Number:
641-456-3612
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  01568 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: INDIVIDUAL 09433 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: INDIVIDUAL 1094334 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: INDIVIDUAL P00285810 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: INDIVIDUAL 203921501 . This is a "COMMERCIAL INSURANCE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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