1952302606 NPI number — DR. DANIEL A ROTHFUSS M.D.

Table of content: DR. DANIEL A ROTHFUSS M.D. (NPI 1952302606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952302606 NPI number — DR. DANIEL A ROTHFUSS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTHFUSS
Provider First Name:
DANIEL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952302606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 266
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIAWATHA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52233-0266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-826-3763
Provider Business Mailing Address Fax Number:
319-826-3766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
MCCREERY CANCER CENTER
Provider Business Practice Location Address City Name:
OTTUMWA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52501-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-684-2480
Provider Business Practice Location Address Fax Number:
647-684-2476
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  24974 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2093757 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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