Provider Demographics
NPI:1992757116
Name:HEPPLEWHITE, DANIEL A (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:HEPPLEWHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 8TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1028
Mailing Address - Country:US
Mailing Address - Phone:515-967-0133
Mailing Address - Fax:515-967-7578
Practice Address - Street 1:2720 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1028
Practice Address - Country:US
Practice Address - Phone:515-967-0133
Practice Address - Fax:515-967-7578
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5074401Medicaid
IA1992757116Medicaid
IA1992757116Medicaid
IAP00274500Medicare PIN
719260251Medicare PIN
IAI13157Medicare PIN