Provider Demographics
NPI:1962622233
Name:MARTIN, DANIEL ALAN (RT(R))
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALAN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E A ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52776-1509
Mailing Address - Country:US
Mailing Address - Phone:319-627-4833
Mailing Address - Fax:
Practice Address - Street 1:601 HWY 6 W
Practice Address - Street 2:VAMC
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-2208
Practice Address - Country:US
Practice Address - Phone:319-338-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography