Provider Demographics
NPI:1861445223
Name:DUVEN, DOUGLAS MARK (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MARK
Last Name:DUVEN
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:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-833-6100
Mailing Address - Fax:319-833-6102
Practice Address - Street 1:1731 W RIDGEWAY AVE
Practice Address - Street 2:STE 100
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4591
Practice Address - Country:US
Practice Address - Phone:319-833-6100
Practice Address - Fax:319-833-6102
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23463208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42141730701OtherJOHN DEERE HEALTH CARE
IA1203869Medicaid
IA19288OtherWELLMARK INS PLAN
IA42141730701OtherJOHN DEERE HEALTH CARE
IA1203869Medicaid