Provider Demographics
NPI:1619939600
Name:HUSS, CHARLES DEWAYNE (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DEWAYNE
Last Name:HUSS
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 1:500 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2689
Mailing Address - Country:US
Mailing Address - Phone:319-339-3600
Mailing Address - Fax:319-339-3786
Practice Address - Street 1:500 E MARKET ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2689
Practice Address - Country:US
Practice Address - Phone:319-339-3600
Practice Address - Fax:319-339-3786
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20691207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0191171Medicaid
IA44210OtherBLUE CROSS BLUE SHIELD
IAI0463Medicare ID - Type Unspecified
IA0191171Medicaid