Provider Demographics
NPI:1942204300
Name:MANSFIELD, DANIEL A (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:MANSFIELD
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 550
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:IA
Mailing Address - Zip Code:52052-0550
Mailing Address - Country:US
Mailing Address - Phone:563-252-1121
Mailing Address - Fax:563-252-5547
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052-9108
Practice Address - Country:US
Practice Address - Phone:563-252-1121
Practice Address - Fax:563-252-5547
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32425208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN211218300Medicaid
IA1183319Medicaid
IA1183319Medicaid
MN211218300Medicaid