The Diagnosis and Treatment of Iron
Deficiency in Primary Care:
34,741 CBCs Reconsidered
OR
What I learned from 55 Gallons of Baby’s
Blood
OR
The Diagnosis and Treatment of Iron
Deficiency in Primary Care:
A Qualified Failure
Three Types of Prevention
(Commission on Chronic Illness, 1957)
• Primary Prevention, which seeks to decrease the number
of new cases of a
disorder or illness;
• Secondary Prevention, which seeks to lower the rate of
established cases of a disorder or illness in the population
(prevalence);
• Tertiary Prevention, which seeks to decrease the amount of
disability associated
with an existing disorder.
Findings:
The secondary prevention of IDA in toddlers is difficult.
Success at CCRMC=30%, in line with four other studies.
Most patients do not receive follow-up (38%) or remain
anemic at follow-up (32%).
Patients who remain anemic at follow-up have been
affected for an
mean of 147 days (range 15-836 days)
Background
Iron deficiency is the most common and
widespread nutritional disorder in the world.
The numbers are staggering: 2 billion people –
over 30% of the world’s population – are
anaemic, many due to iron deficiency.
Why do we care?
Iron is a cofactor in 200 enzymes and is
important for various functions such as:
•Oxygen carriage in Hb
•Respiration
•Neurotransmitter synthesis
•Myelination
Performance Problems
•Temporal organization of sleep
•WISC-R intelligence test
• Average math scores
•Written expression, motor functioning, and
some specific cognitive processes
Neurological Findings ( Young Humans)
• The hearing abilities, verbal and non-verbal
sequential memory and localization
• Abnormal Visual Evoked Potential
• EEG and cognitive EPs (CEPs).
Behavioral Findings (Animals)
•Wisconsin General Testing Apparatus,
Black/White Discrimination task was
acquisition of Black/White Reversal (BWR)
(Monkeys).
•Decreased activity and stereotypic behavior
(Rats).
•Hippocampus-dependent learning (Rats)
What is the Gold Standard for the Diagnosis of
ID?
Bone Marrow
What are the Clinical Diagnostic Criteria for
Iron Deficiency?
Two Clinical Models
Ferritin Model
(NHANES III)
2 or 3 of Following Abnormal:
•Low Ferritin
•Low Transferrin Saturation
•Hi Erythrocyte Protoporphyrin
Body Iron Model
(NHANES 2003-Onwards)
A Function of
1) Transferrin Receptor (Tfr)
To
2) Ferritin
Body iron (mg/kg) =
-[log10 (TfR*1000/ferritin)
-2.8229]/0.1207
Anemia Is a Poor Predictor of Iron Deficiency
Among Toddlers in the
United States: For Heme the Bell Tolls
Keith C. White, MD
2005;115:315–320;
In this study, ID was diagnosed if >=2 of the
following pertained:
•ferritin <10 g/L
•transferrin saturation <10%
•EPP> 1.42 mol/L red blood cells.
•Anemia was diagnosed if [Hb] was 110 g/L
•IDA was diagnosed if anemia accompanied ID
Sample Cohort:
893 Toddlers
↓Hb ↓MCV ↑RDW
(PPV for ID=93%)
341 Lost to Follow-up
(38%)
552 Followed Up
268 “Cured”
(30%)
i.e. 2nd Hb>11.0 g/dL
284 Still Anemic
(32%)
Demonstrated duration of disease=
147 days (mean)
range 15-836 days
Extraordinary Thanks
to Maura Hoag
AARDEN,PYRA M,MD
Arora,Ravi,MD
BROWN,BENJAMINA
Berkowitz,Shelly, M.D.
CARDOZA,MARY
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DASARI,RAJ
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Faivre,Scott R,DDS
Furtado,Marcia
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DASARI,RAJ,MD
Dooley,Diane,MD
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GEE,JOHN
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DAVIS,BRIAN,MD
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GILBERT,JOHN I
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DAWLEY,COURTNEY A,MD
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GIRI,VASANTA,MD
Chavez,Frances,MD
DEHLINGER,MAIA,FNP
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JACKSON,JONATHAN,MD
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Helmstein,Jean,FNP
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GRAHAM,OLIVER Z,MD
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HJORTSVANG,ERICK,MD
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JENKINS,WILLIAM,MD
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Graves-Matthews,Mcheko,M.D.
HOFSTADLER,GUENTER,MD
Hernandez,Estela,MD
JEUNG,JOAN J,MD
GRIMES,GARY,MD
Green,Trinh M,MD
HOLMES,MICHELLE,MD
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JIANG,XIAOHUA,MD
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JOHNSON,GWENDOLYN,MD
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Higgins,Cheryl,FNP
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GROSS,JOEL,MD
Grondahl,Joseph M,MD
HOPKINS,JAMES M,MD
Hilaman,Brad L,MD
Jacobs,Beverly,FNP
GROSS,LAURA MD
HAGLUND,KIMBERLEY,MD
HOWARD,RENEE,MD
Hilty,Jill,M.D.
Jacobs,Jeffrey,MD
GROSS,LAURA,MD
HAHN,DAVID,DO
HSIEH,CHARLOTTE,MD
Hiner,Sharon,MD
Jacobs,Lyn
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Jagust,William,MD
GROSSNICKLE,ELLEN,MD
HAMILTON JR,GEORGE,MD
HUBIAK,MELISSA,MD
Hines,Pamela,MD
Jain,Nidhi,MD
GWALANI,TULSIDAS,MD
HANLIN,DOUGLAS,MD
HUMELBAUGH,GIA
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Javaheri,Shahin M,MD
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HANSEN,ANNIKEN,MD
HUYNH,HUONG,MD
Hinman,Priscilla,MD
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Ghori,Imtiaz
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Ghori,Imtiaz,MD
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Glatt,Patricia,M.D.
HELMSTEIN,JEAN
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Glatt,Patricia,MD
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Huie,Fredric,MD
KAMALNATH,JACINTHA
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Hay,Sunathara,DO
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KANE,LESLEE,MD
Goodman,Susan R.,M.D.
HINDI,ROBERT, MD*
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KANG,HANNA,MD
REITZENSTEIN,JONATHAN,MD
Ringo,Patrice M,MD
SCHREIER,HERBERT M.D.
SPOONER-DEAN,KERRY,M.D.
RHODES,GREGORY A,MD
Risgalla,Edward,MD
SCOTT,MALAIKA M,MD
STALLINGS,RONALD,MD
RIDDEL,JIM,NP
Roberts,Jessica B,MD
SEBAN,OLIVER,MD
STEBER,BRIAN,MD
RILEY,JENNY,MD
Roberts,John Paul,MD
SEED,CHRISTINA,DO
STEELE WOODALL,VICKY,FNP
RINGO,PATRICE,MD
Robinson,Curtis,M.D.
SEGALL,SERGE S,DDS
STEELMAN,MARIA,MD
RISGALLA,EDWARD,MD
Rodarte,Christopher,M.D.
SHAH,NISHANT H,MD
STEFFENSON,SANDRA,MD
ROBC
Roe,Taiyun,MD
SHAH,SAMIR,MD
STEIN,MICHAEL R,MD
ROBERTS,JESSICA,MD
RomeroDuran,Adolfo,MD
SHAIN,PHILIP,MD
STEINER DOOHAN,NOEMI,MD
ROE,TAIYUN,MD
Roos,Joan
A,FNP
SHANAHAN,ROBIN,MD
STEINHART,RACHEL,MD
ROHWEDER,DANIEL A,MD
Roos,Joan,FNP
SHATZ,ARNOLD,MD
STEIRN, FNP
Schaffer,Sarah,MD
ROMERO-DURAN,ADOLFO,MD
Rosenfeld,Jack,DDS
SHAW,MAYA S,MD
STEIRN,FNP
Schaplow,Reagan,MD
ROMO,CECILIA
Rosenthal,Macey H,MD
SHEFA,MEHDI,MD
STETTNER,MICHAEL,FNP
Schechtman,Andrew,MD
ROSENTHAL,PHILIP MD
Rosenthal,Macey,MD
SHEFA,Q,MD
STEUBLE,B
Scheffer,Jonathan
L,MD
ROSENTHAL,PHILIP,MD
Ross,William,M.D.
SHELDON,WILL C,MD
STYCH,DEBORAH,FNP
Scherzberg,Maureen,FNP
ROSS,CHRISTINE,MD
Rudlowski,Teresa,MD
SHELTON-PRYOR,RUTH E,MD
SWARZENSKI,BARBARA,MD
Schnake,Ann L,FNP
ROUX,JOAN W,MD
Rush,Philip,MD
SHOVLIN,PATRICIA M,MD
Saffier,Kenneth A,MD
Schnake,Ann,FNP
RUDA,STEPHEN,DO
SACHDEV,
NEELAM,MD
SIEGAL,JENNIFER
Saffier,Kenneth,MD
Schneider,Jeanette E, M.D.
Rafal,Robert,MD
SACHDEV,JANAK,MD
SIEGEL,ALAN,MD
Safianoff,David,MD
Schreiber,John,MD
Randles,Bradley,MD
SACHDEVA,SURESH,MD
SILVERSTEIN,STUART C,MD
Saito,Hideto,MD
Schwamberger,Shelle,MD
Rapa,Katarzyna W,MD
SAHEBKAR,FARHAD M,MD
SIMMONS,JILL (HILTY)
Salceda,Irene A,PA
Schwartz,Jerrold,MD
Raphael,David,MD
SALSBURG,ELIZABETH L,MD
SIMONWEISBERG,DEBORAH,MD
Sam,Michel,MD
Schwedes,Judith,MD
Raumer,Sheila,MD
SAMPSON,OLIVIA,MD
SINHA,NANDA,MD
Sandler,Andrea E,MD
Scott,Malaika M,MD
Reedy,David B,MD
SANDLER,ANDREA,MD
SKOCHKO,GREG,MD
Sandler,Maurice,MD
Seawell,Elaine O,FNP
Reese,Cote
SAPIEN,ROBERT E,MD
SMITH
Sands,Michael,MD
Seawell,Elaine O.,FNP
Reif,Paul,MD
SARASUA,JAMES,MD
SMITH,CHRISTINE B,FNP
Santiago,Daniel E,MD
Severson,G. Kaye,FNP
Reilly,Brenda,MD
SAUERLAND,EBERHARDT,MD
SMITH,THOMAS J,MD
Sapien,Robert E,MD
Shaffer,Ingeborg,MD
Reisman,Jeanne,MD
SAVAGE,CYNTHIA,MD
SOLIS,ROBERTO A,MD
Sarvasy,Paul,MD
Shah,Nishant H,MD
Render,Rebecca M,DO
SCHAFFER,GERALD, MD*
SOLOMON,DAVID J,MD
Sarvi,Saunaz,DDS
Shalen,William
Reynolds,Nancy,MD
SCHEFFER,LISA G,MD
SONG,JACK,MD
Saucedo,Jesus,M.D.
Sharma,Aditya,MD
Reynolds,Vera,FNP
SCHESSER,JONATHAN,MD*
SORIA,RAFAEL,MD
Savage,Cynthia J,MD
Shaw,Howard,FNP
Riccio,Adrienne,RN
SCHIFFMAN,LOLLY,MD
SORRELL,ARTHUR,MD
Savage,Walter T,MD
Shaw,Maya S,MD
Rice,Abraham C,MD
SCHMIDT,D SCOTT,MD
SPAIN,ALAN J,MD
Sayani,Sam,MD
Shaw,Michael
Riedel,J Frederick,MD
SCHNEIDER,LUREE,MD
SPANGLER,LINDA,MD
Siegel,Alan L,MD
Sheldon,Will
C,MD
Siegel,Jennifer,M.D.
Stone,David,MD
Treatment,Nurse
WARNE,THOMAS,MD
Weiner,Ira,MD
Sigmond,Herbert,MD
Stringer,Penney C,MD
Tremain,Steven,MD
WASHINGTON,SHARON D,MD
Weingard,Herbert,MD
Simon-Weisberg,Deborah,MD
Strych,Deborah,FNP
Truman,Kirsten C,MD
WATERS,SHANNON,MD
Weinreich,Don H,MD
Singh,Deviner,MD
Su,Cindy W,MD
Tsai,Clark
S,MD
WATSON,JOHN,MD
Weiss,Stephen,MD
Skinner,Harry,MD
Suchow,David,MD
Tsai,Tsuong,MD
WEBB,KINARI,MD
Weng,Christiana Y,MD
Slauson,Dana L,MD
Sutherland,Sonia,MD
Tsang,Jennifer,MD
WEI,ALAN,MD
Werner-Crohn,Mindy,MD
Slauson,Dana,MD
Swartz,Aubrey,MD
Tysell,James R,MD
WEIGOLD,SCOTT,MD
Wernham,Aaron A,MD
Smallhorne,Violet,MD
TAI,DENICE K,MD
Tysell,James,MD
WEILAND,DAVID S,MD
Westerman,Jennifer,FNP
Smick,Kathryn,MD
TANG,JOYCE,MD
Tzvieli,Ori,MD
WEINMAN,CHRISTIAN,MD
Whalen,Jon,MD
Smith,Daryl,MD
TANTOD,BHAKTI,MD
UDENYI,NKECHINYERE,MD
WENG,CHRISTIANA,MD
White,Keith C,MD
Smith,James,MD
TAVERNIER,LAURA,MD
UNASSIGNED PCP
WHINNERY,CATHERINE,MD
White,Keith,MD
Smith,Jeffrey V,MD
TAYLOR,DENISE
UNDERWOOD,VIRGINIA,MD
WHITE,CHRISTINE,FNP
White,Matthew P,MD
Smith,Nora,MD
TODD,MICHAEL,MD
UNIS,CLAIRE,MD
WHITE,NEAL,MD
White,Ralph Devere,MD
Smith,T,MD
TODD,RODNEY,MD
Urcuyo,Sergio,MD
WHITE,VANEIDA,MD
White,Thomas,MD
Sobel,Daniel,MD
TOMASULO,MICHELE,FNP
VALVERDE
WHITEHAIR,BREA,MD
Wildfire,Gila,MD
Solomon,David
J,MD
TORNABENE,FELICIA,MD
VALVERDEE
WHITEHALL,JUDI,MD
Wille,Mark,MD
Song,Jack J,MD
TREATMENT,NURSE
VAN HANDEL,MARK,MD
WHITTEN,LAURA F,MD
Williams,Kathryn,MD
Sorensen,Gregg S,MD
TREYGER,LEONID,MD
VAN MEURS,DIRK,MD
WIDDER,DONALD J,MD
Williams,Tanya M,MD
Spalding,Joanne,MD
TZVIELI,ORI,MD
VAN
ORDEN,FRANK,MD
WILDFIRE,GILA,MD
Wong,Bryan M,MD
Standefer,Charlotte B,MD
Tai,Denice
K,MD
VAN SCHAVEN,EMILY,MD
WILLIAMS,ROGER,MD
Wong,DAN K,DDS
Standefer,Charlotte,MD
Tangco,Angelita,MD
Van Duren,Michael,M.D.
WIXOM,PHILIP A,MD
Wong,Michelle,MD
Stanger,Jennifer,MD
Tantod,Bhakti D,MD
Van Duren,Michael,MD
Wadle,Dawn
Marie,MD
Wong,Sharman,OD
Stanger,Jonathan R,MD
Taylor,Denise,MD
Van
Konynenburg,Kristin,MD
Wagner,Andrea,MD
Wright,Lara M,MD
Staniotes,Lizabeth N, M.D.
Taylor,Opal
I,MD
Vastine,David R,MD
Wagner,David,MD
YANG-SHARMA,PATRICE,MD
Steinberg,Jonathan
D,DPM
Tendero,Clarissa,MD
Von Rydingsvard,Milton,M.D.
Walker,Scott,DDS
YASUL,JOSE,MD
Steinberg,Susann,M.D.
Tenduf-La,Tenki,MD
Vonbuettner,Marion,MD
Walker,Susan J,MD
YATES,RACHEL L,MD
Steinhart,Rachel,MD
Thedinger,Blair,MD
Vonrydingsvard,Milton,MD
Walker,William,MD
YOO,DAVID,MD
Steirn,Cathy,FNP
Thomas,Cecilia,DDS
WAGNER,DAVID,MD
Walsh,John R,MD
Yang-Sharma,Patrice,MD
Stephens,Claudell,MD
Thomas,Michelle,MD
WALKER,BRADLEY,MD
Walsh,Judith M,MD
Yasul,Jose I,MD
Stephenson,Linda,FNP
Timmerman,Laura A,MD
WALKER,MIGNON,MD
Walsh,Judith,MD
ZAKS,CAMILO C,MD
Stern,Richard S,MD
Toma,Louay,MD
WALSH,JOHN,MD
Warne,Thomas
R,MD
ZELAN,SAUL,MD
Stewart,Jerome,MD
Tomasulo,Michele,FNP
WANG,CATHERINE,MD
Warner,Deborah,MD
Zaks,Camilo C,MD
Stinson,Mark,MD
Trapnell,James,MD
WANG,LINA,MD
Wasko,Janet,FNP
Zaks,Walter,MD
Zimmerman,Daniel,MD
Zerweck,Bradley W,MD
Zamani,Christopher,MD
KASTEN,THOMAS,MD
Keller,Lisa K,MD
LEGGETT,MICHELLE
Lee,Rebecca,MD
KAUR,RAMANDEEP,MD
Kelley,Juliette,MSS
LEHMAN,TARA,MD
Legg,Jill J,MD
KEATING,LIAM,MD
Kelly,Olga D,MD
LEIGH,ERICA,MD
Lehman,Tara A,MD
KEBEBEW,POSITRON,MD
Kemmet,Rebecca K,MD
LEIGHTON,LYNETTE
Leong,Craig,M.D.
KELLY,KRISTEN
Kershnar,Rebecca L,MD
LERMAN,BENJAMIN S,MD
Leong,Rudy,M.D.
KELLY,OLGA,MD
Keswani,Anita,MD
LEWIS, NANCY
E,MD
Levin,Robert,M.D.
KENT,ZACK,MD
Kim,Hye-Kyung,MD
LEWIS,BRAD,MD
Levin,Sara K,MD
KERLEY,SARA,MD
Kleinerman,David I,MD
LEWIS,ELISE,MD
Lewis,Elise A,MD
KERSHNAR,REBECCA,MD
Kleinerman,David,MD
LEWIS,STEPHEN B
Lin,Alice,MD
KEVAN,
JONATHAN
Kline,Todd M,MD
LIN,ALICE,MD
Lindsay,R. J.,M.D.
MAYLAND,GABRIEL,MD
KHAN,FARINA,RN
Knight,Robert,MD
LIN,JANET,MD
Lindsey,David,M.D.
MCADAMS,LANCE,MD
KHOURY,RONALD,MD
Koo,Ralph A,MD
LIN,MARGARET,MD
Lipson,John H,MD
MCBRIDE,PAMELA,MD
KIBELSTIS,THOMAS,MD
Kramer,Theresa,MD
LINDE,BRIAN,MD
Lively,Daniel, M.D.
MCCARTHY,CLAIR,MD
KISSINGER,CATHY,FNP
Kulinsky,Ilya,MD
LINN-MAKUA,LIZABETH,FNP
Lockhart,Ann B,MD
MCCARTHY,EVE A,FNP
KONKK
Kullar,Ravjeet K,MD
LIPSON,JOHN H,MD
Loeliger,Scott F,MD
MCCORMICK,JANE,MD
KOO,RALPH
A,MD
Kumar,Pradeep,MD
LOCKHART,ANN,MD
Long,THOMAS
MCCOY,THOMAS C,DO
KRUTZ,REBECCA A,MD
LAI,JAY
LOEFFLER,ANN M,MD
Longoria,Anthony M,FNP
MCDANIEL,MARC
KULLAR,RAVJEET,MD
LAM,WENDY
LOELIGER,SCOTT,MD
Lopez,Carlos,M.D.
MCDONALD,THOMAS,MD
KULOVSKY,SUSAN M,DO
LAMANUZZI,SARAH MD
LONGORIA,ANTHONY M,FNP
Lopez,Hector J.,MD
MCENTEE,AMY,MD
KURUVILLA,PRAMITA,MD
LAXAMANA, DARLEEN DDS
LOTRIDGE,JESSICA,MD
Lucey,Bette B,FNP
MESSINGER,JEFFREY,MD
Kailikole,Theresa,MD
LEACH,RANDY A,MD
LUCEY,BETTE,FNP
Lum,Karen, M.D.
MEYER,JACOB
M,MD
Kaji,Troy T,MD
LEAVITT,JONATHAN
LUM,KAREN
Luong,Lien,MD
MEYER,JENNIFER,MD
Kalkstein,Stephen W,MD
LEE,BRIAN,P,MD
LYONS,MICHAEL,MD
MACCHOR,NADAL
MEYER,LEIF
Kalra,Sumita K,DO
LEE,DANIEL A,MD
Lackman, M. MD
MACEDO,JOSEPH,MD
MILLER,DAVID,MD
Kamalnath,Prakash J,MD
LEE,ERIN M MD
Lantz,Donald J,MD
MAHAR,DIANA,MD
MILOJEVIC,DIANA MD
Kang,Hanna,MD
LEE,GEORGE,MD
Lantz,Donald,MD
MAHONEY,JOHN
MINDY WERNER-CROHN, MD
Karell,Manuel L.,M.D.
LEE,JAMES, MD
Lares,Beatriz,M.D.
MALIK,RITU,MD
MIRAMONTE,
SHELLY
Karpf,Esther,FNP
LEE,KAI-MAN,MD
Laxamana,Darleen G,DDS
MANUNTAG,WILFRED
MIRANDA,KRISTEN
Kartun,Karen F,MD
LEE,MICHAEL
Lee,Daniel A,MD
MANUNTAG,WILFREDO,MD
MOELLER,KRISTIN,MD
Katz,Samuel,MD
LEE,SCOTT,MD
Lee,EunKyu,M.D.
MARTINEZ,DAVID,MD
MOHR,ARWEN,MD
Katzman,Kenneth A,MD
LEE,SU-MAY,MD
Lee,John M,MD
MARTINEZ,MICHAEL S,MD
MONTANDON,MICHELE,MD
Katzman,Kenneth,MD
LEE,TABESSA I,MD
Lee,John,M.D.
MATSUNAGA,ALISON T,MD
MOORE,JUDE J,MD
Kaufman,Douglas,MD
LEGG,JILL J,MD
Lee,Michelle,MD
Keating,Liam,MD
MORAN,BRIDGET,FNP
MORGAN,JAMES,MD
Martinez,Michael S,MD
Morrison,Chantal L,DO
PABERS,JOHN,MD
Perez,Edith,MD
MORRISON,CHANTAL L,DO
Matsumura,Gary,MD
Mueller,Robert A,MD
PACKMAN,SEYMOUR,MD
Perez,Greta,MD
MOULTON-BARRETT,REX,MD
Matsunaga,Alison T,MD
Murai,Sarah E,MD
PAIGE,THOMAS,MD
Perez,Pauline,MD
MOZA,JOSEPH,MD
Mattka,F J,DDS
NAIMA,IRAJ,MD
PALMER,NANCY,MD
Perez,Peter J,MD
MUNNICH,JO MARIE,MD
May,Daniel,MD
NATION,ROMAN,MD
PALOMINO,MICHAEL A,MD
Perez-Baron,Gina,MD
MURAI,SARAH,MD
Mbanugo,Ogo S,MD
NAVEL,DAVID,MD
PALOMINO,MICHAEL A,MD
PerezSalinas,Dalia
MacDannald,Harry,MD
Mbanugo,Ogo,MD
NAVEL,JAMIE,MD
PAYNE,CHELSEA,MD
Perlas,Maria K,MD
MacDonald,David J,MD
McAnich,Jana,MD
NGUYEN,DAO M,MD
PEHLING,JAMES R,MD
Perry,Alison W,FNP
MacDonald,David,MD
McAninch,Jack W,MD
NGUYEN,LOAN,DO*
PEPPER,DAVID,MD
Peterson,William J,MD
Macedo,Joseph J,MD
McCabe,Robert,MD
NGUYEN,MYHOANG,MD
PEREZ,JUAN,MD
Pham,Julie,DO
Madrigal,Teresa,MD
McCoy,Thomas C,DO
NIX,DEBBIE,FNP
PEREZ-BARON,GINA,MD
Picker,Robert,MD
Magbitang,Fereyes,MD
McDaniel,H Marc,MD
Nagel,Charlotte,MD
PERLAS,JANE,FNP
Pierson-Brown,Leigh,FNP
Mahan,Bernadette
McDonald,Diana,FNP
Navel,Jamie
M,MD
PESSL,ERICH,MD
Pilcher,David W,MD
Mahar,Dennis,MD
McDonald,Michael
Nelson-Munson,Karen,MD
PETERSON,AARON,MD
Pillai,Sangita S,MD
Mahar,Diana H,MD
McNabb,Thomas R,MD
Nguyen,Myhoang P,MD
PETERSON,WILLIAM J.,MD
Pinto,Natasha J,MD
Maher,Patrick,MD
McNeil,Sarah,MD
Nidorf,David,MD
PETTIT,CHARLES R,MD
Pitman,Dorothy,M.D.
Maher,Terry,MD
Melny,Richard,MD
Nix,Debbie,FNP
PHAM,AN T,MD
Pizzo,Anthony,FNP
Makhoul,Nicolas E,M.D.
Mendoza,Julio,DDS
Nordensjo,Anna K.,M.D.
PHELPS,BRIAN,MD
Polzin,David,MD
Makhoul,Nicolas E,MD
Mendoza,Zenaida M,MD
O'LEARY,MAURA,MD
PIERSON-BROWN,LEIGH,FNP
Porter,William,MD
Makow,Adele,MD
Mendoza,Zenaida, M.M.D.
O'MEANY,JUAN F,PA
PIERSON-BROWN,LEIGH-ANNE,FNP
Pramanik,Rajiv,MD
Malik,Geeta,M.D.
Meyer,Jacob M,MD
OLDHAM,DEREK,RES
PINTO,NATASHA,MD
Public
Health,Pittsburg
Malik,Rajiv,MD
Meyers,Leif E,MD
ONISKO,NANCY,DO
POLLICK,CHRISTOPHER,MD
Public Health,Richmond
Malik,Ritu,MD
Miller,Barry,M.D.
OWENS,MELISSA K,MD
PONOMAREFF,GEORGE,MD
Puell,Michael A,MD
Mallen,Peter R,MD
Miller,Daphne,M.D.
OZAETA,LEE,MD
POPULIS,AMELIA
Puell,Michael,MD
Mandiberg,Robert
L,MD
Miller,Fred,MD
Olsen,Harvey,MD
PRAMANIK,RAJIV,MD
QADIR,MALIHA,MD
Mansour,Karim M,MD
Miller,Laura FNP
Olsen,Richard,M.D.
PRESCOTT,STACY MD
QUIDES,KATHY,N.P.
Manuntag,Wilfredo P,MD
Miller,Michael,M.D.
Olsen,SteveN
PRIVATE
DOCTOR
QUINONES,LISA M,MD
Maramonte,Shelly M,MD
Milojevic,Diana,MD
Olson,Donald,MD
PRYSI,SCOTT,MD
Quinones,Lisa M,MD
Maramonte,Shelly,MD
Moeller,Kristin A,MD
Onisko,Nancy
S,DO
Paige,Thomas N,MD
RANA,FARAH,MD
Marchand,Erin,MD
Mohr,Arwen E,MD
Osborne,David F,MD
Palmer,Nancy K,MD
RAO,KALPANA,MD
Maron,Steven,MD
Montandon,Henri E,MD
Osborne,Frederick M,MD
Parkison,Gary,M.D.
RAPA,KATARZYA,MD
Marten,Timothy,MD
Montandon,Michele M,MD
Owen,Kenneth Dale,M.D.
Pearson,Meg
RASKIN,GORDON,MD
Martin,Albert E,DDS
Morrell,Rose E,MD
Owens,Nancy,M.D.
Pehling,James
R,MD
REEDY,DAVID B,MD
Martin,Gail E.,M.D.
Morrell,Rose,MD
Owens,Nancy,MD
Pepper,David R,MD
REILLY,BRENDA,MD