Healthcare Provider Details

I. General information

NPI: 1427984756
Provider Name (Legal Business Name): CHARLES JOSEPH LEARY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

201 SE 6TH ST APT 411
DES MOINES IA
50309-4850
US

V. Phone/Fax

Practice location:
  • Phone: 515-867-7934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR-14016
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: