Provider Demographics
NPI:1881645273
Name:LOUIE, WASON W (MD)
Entity Type:Individual
Prefix:
First Name:WASON
Middle Name:W
Last Name:LOUIE
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 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4342
Practice Address - Street 1:800 MERCY DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3128
Practice Address - Country:US
Practice Address - Phone:712-328-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35663207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03665OtherBCBS
IA37051OtherWELLMARK BCBS
NE39-01956OtherSHAREADVANTAGE
39-01958OtherSHARE ADVANTAGE IOWA
NE100249951-00Medicaid
IAP00170245OtherRRMEDICARE IOWA
IA0719153Medicaid
NE100251147-00Medicaid
NE100251217-00Medicaid
NE39-01955OtherSHAREADVANTAGE
IA0443440Medicaid
04307OtherBCBSNE FOR IOWA
NE244686OtherMLDCH & MUTUAL OF OMAHA
IA4443440Medicaid
IA37051OtherWELLMARK BCBS
IAP00170245OtherRRMEDICARE IOWA
IAI14535Medicare PIN