Healthcare Provider Details

I. General information

NPI: 1124112719
Provider Name (Legal Business Name): JAMES STACEY KLUTTS M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NEWTON RD DEPT OF PATHOLOGY, ROOM 137 MRC, UNIV. OF IOWA COM
IOWA CITY IA
52242
US

IV. Provider business mailing address

601 HIGHWAY 6 W VAMC; PATHOLOGY (113)
IOWA CITY IA
52246-2292
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-0581
  • Fax:
Mailing address:
  • Phone: 319-338-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number2002011767
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number37279
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: