Provider Demographics
NPI:1326045808
Name:STURDEVANT, RAY C (MD)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:C
Last Name:STURDEVANT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1125 PIERCE ST
Mailing Address - Street 2:STE 100
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1484
Mailing Address - Country:US
Mailing Address - Phone:712-255-8901
Mailing Address - Fax:712-255-9161
Practice Address - Street 1:2800 PIERCE ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3755
Practice Address - Country:US
Practice Address - Phone:712-255-8901
Practice Address - Fax:712-255-9161
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2017-04-27
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Provider Licenses
StateLicense IDTaxonomies
IA19856208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0128470Medicaid
IAA01130Medicare UPIN
IA0128470Medicaid