Healthcare Provider Details

I. General information

NPI: 1245899707
Provider Name (Legal Business Name): GLORIA CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR DEPT OF
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR DEPT OF
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-2902
  • Fax: 319-356-8682
Mailing address:
  • Phone: 319-356-2902
  • Fax: 319-356-8682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR-11528
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: