Provider Demographics
NPI:1245269810
Name:RAUSCH, DANIEL P (M D)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:RAUSCH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 RIDGEWATER DR STE A
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-8977
Mailing Address - Country:US
Mailing Address - Phone:406-883-3200
Mailing Address - Fax:406-883-9483
Practice Address - Street 1:106 RIDGEWATER DR STE A
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-8977
Practice Address - Country:US
Practice Address - Phone:406-883-3200
Practice Address - Fax:406-883-9483
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0145405Medicaid
MT0145405Medicaid