Provider Demographics
NPI:1124112719
Name:KLUTTS, JAMES STACEY (MD, PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:STACEY
Last Name:KLUTTS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HIGHWAY 6 W
Mailing Address - Street 2:VAMC; PATHOLOGY (113)
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2292
Mailing Address - Country:US
Mailing Address - Phone:319-338-0581
Mailing Address - Fax:
Practice Address - Street 1:500 NEWTON RD
Practice Address - Street 2:DEPT OF PATHOLOGY, ROOM 137 MRC, UNIV. OF IOWA COM
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-338-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011767207ZP0105X
IA37279207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55071OtherWELLMARK BCBS
IA55110OtherWELLMARK BCBS
IA55110OtherWELLMARK BCBS
IA55071OtherWELLMARK BCBS
IAI20792Medicare PIN
IAI0923270Medicare PIN