Provider Demographics
NPI:1912983966
Name:ASKELSON, DAVID L (PAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:ASKELSON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:IA
Mailing Address - Zip Code:52216-9744
Mailing Address - Country:US
Mailing Address - Phone:563-452-3211
Mailing Address - Fax:563-452-3215
Practice Address - Street 1:411 1ST AVE
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:IA
Practice Address - Zip Code:52216-9744
Practice Address - Country:US
Practice Address - Phone:563-452-3211
Practice Address - Fax:563-452-3215
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA970011410OtherRR MEDICARE
IA970011402OtherRR MEDICARE
IA970011412OtherRR MEDICARE
IAS57433Medicare UPIN
IA13330Medicare ID - Type Unspecified