Provider Demographics
NPI:1063400869
Name:BENDA, JO A (MD)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:A
Last Name:BENDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-4436
Mailing Address - Fax:319-384-8052
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-4436
Practice Address - Fax:319-384-8052
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20340207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33927OtherWELLMARK BCBS
IA16962OtherWELLMARK BCBS
IA0169623Medicaid
IA1169623Medicaid
IA16962OtherWELLMARK BCBS
IA33927OtherWELLMARK BCBS
IA1169623Medicaid
IA0169623Medicaid