Basic Information
| Provider Information | |||||||||
| NPI: | 1972558229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIELS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5885 SUNNYBROOK DR | ||||||||
| Address2: | E-100 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511064203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122662700 | ||||||||
| FaxNumber: | 7122662759 | ||||||||
| Practice Location | |||||||||
| Address1: | 5885 SUNNYBROOK DR | ||||||||
| Address2: | E-100 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511064203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122662700 | ||||||||
| FaxNumber: | 7122662759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 29410 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 29410 | IA | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 10513 | 01 | IA | MIDLANDS CHOICE - HOSPITA | OTHER | 421283849-46 | 05 | IA | MEDICAID | 33131 | 01 | IA | WELLMARK BCBS IA - HOSPIT | OTHER | 3100255 | 05 | IA | MEDICAID | 3821943 00 | 05 | IA | MEDICAID |