Healthcare Provider Details

I. General information

NPI: 1003874264
Provider Name (Legal Business Name): ASHRAF ADEL SAMY GERGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIAMOND ST
ONAWA IA
51040-1548
US

IV. Provider business mailing address

2213 GRAND AVE
DES MOINES IA
50312-5305
US

V. Phone/Fax

Practice location:
  • Phone: 712-423-2311
  • Fax: 712-423-3500
Mailing address:
  • Phone: 515-237-3974
  • Fax: 515-883-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29853
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: