Provider Demographics
NPI:1952302606
Name:ROTHFUSS, DANIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:ROTHFUSS
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 266
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-0266
Mailing Address - Country:US
Mailing Address - Phone:319-826-3763
Mailing Address - Fax:319-826-3766
Practice Address - Street 1:1003 PENNSYLVANIA AVE
Practice Address - Street 2:MCCREERY CANCER CENTER
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2108
Practice Address - Country:US
Practice Address - Phone:641-684-2480
Practice Address - Fax:647-684-2476
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA249742085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2093757Medicaid
IAB41651Medicare UPIN
IA2093757Medicaid