Provider Demographics
NPI:1619937026
Name:DANIELSON, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:DANIELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2710
Mailing Address - Country:US
Mailing Address - Phone:563-359-3949
Mailing Address - Fax:
Practice Address - Street 1:1970 E 53RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2710
Practice Address - Country:US
Practice Address - Phone:563-359-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA288012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300132296OtherRR MDC WITH RGIC LLC
51480OtherBCBS IA WITH RGIC LLC
IA1114868Medicaid
IA20789OtherBCBS OF IOWA W/ ORA
IA3114868OtherMEDICAID IOWA W/ ORA
300055679OtherRR MDC WITH RGPCSC
IA300123177OtherRAILROAD MEDICARE W/ ORA
IA6114868Medicaid
IA20789OtherMEDICARE W/ ORA
51337OtherBCBS IA WITH RGPCSC
IAK51234OtherMEDICARE ORA ILLINOIS
51480OtherBCBS IA WITH RGIC LLC
I6039Medicare ID - Type UnspecifiedMEDICARE RGICLLC
IA300123177OtherRAILROAD MEDICARE W/ ORA