Provider Demographics
NPI:1043240526
Name:CHRISTY, PAMELA J (DO)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:J
Last Name:CHRISTY
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 496
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52626-0496
Mailing Address - Country:US
Mailing Address - Phone:319-878-3524
Mailing Address - Fax:319-878-3524
Practice Address - Street 1:202 S 2ND ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:IA
Practice Address - Zip Code:52626-9105
Practice Address - Country:US
Practice Address - Phone:319-878-3524
Practice Address - Fax:319-878-3524
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0269662Medicaid
IA26966OtherWELLMARK
IAEO6902Medicare UPIN
IA0269662Medicaid