Provider Demographics
NPI:1275763369
Name:REPP, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:REPP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5335 EASTERN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2788
Mailing Address - Country:US
Mailing Address - Phone:563-213-5080
Mailing Address - Fax:563-355-5070
Practice Address - Street 1:5335 EASTERN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2788
Practice Address - Country:US
Practice Address - Phone:563-213-5080
Practice Address - Fax:563-355-5070
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2016-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MN53448207W00000X
WAMD60309754207W00000X
IAMD-42656207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00954327OtherRAILROAD MEDICARE
MN180001473Medicare PIN