Provider Demographics
NPI:1316932064
Name:ST JOHN, DONALD D (MA PA)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:D
Last Name:ST JOHN
Suffix:
Gender:M
Credentials:MA PA
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:319-353-6314
Mailing Address - Fax:319-353-7788
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:319-353-6314
Practice Address - Fax:319-353-7788
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA984363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA54732OtherWELLMARK BCBS
IA54732OtherWELLMARK BCBS
S25366Medicare UPIN