Provider Demographics
NPI:1386899086
Name:POTT-PEPPERMAN, DANIEL EPHRAIM (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL EPHRAIM
Middle Name:
Last Name:POTT-PEPPERMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50304-0997
Mailing Address - Country:US
Mailing Address - Phone:515-664-2681
Mailing Address - Fax:515-223-2371
Practice Address - Street 1:400 LOCUST ST
Practice Address - Street 2:SUITE # 400
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2331
Practice Address - Country:US
Practice Address - Phone:515-664-2681
Practice Address - Fax:515-223-2371
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001024103TC0700X
CO3564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180710719Medicaid
IAP00816719OtherMEDICARE RAILROAD
IA1386899086Medicaid
IAP00816719OtherMEDICARE RAILROAD
AR5G142Medicare PIN