Provider Demographics
NPI:1790751006
Name:SAMPEL, DAVID D (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:SAMPEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8203
Mailing Address - Country:US
Mailing Address - Phone:515-241-2300
Mailing Address - Fax:515-241-2305
Practice Address - Street 1:6000 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8203
Practice Address - Country:US
Practice Address - Phone:515-241-2300
Practice Address - Fax:515-241-2305
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00053103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1790751006Medicaid
IA03692Medicare PIN
IA1790751006Medicaid