Provider Demographics
NPI:1821095027
Name:PEASLEY, DANIEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:PEASLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1223 S GEAR AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1682
Mailing Address - Country:US
Mailing Address - Phone:319-768-1520
Mailing Address - Fax:319-758-1530
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:#205
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1682
Practice Address - Country:US
Practice Address - Phone:319-768-1520
Practice Address - Fax:319-768-1530
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA03066207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA58751OtherBLUE CROSS
IAP00325160OtherRAILROAD MEDICARE
IA1151191Medicaid
IA1151191Medicaid
IAI17713Medicare PIN