Provider Demographics
NPI:1770587453
Name:MOUW, LOREN J (MD)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:J
Last Name:MOUW
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 668
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-0668
Mailing Address - Country:US
Mailing Address - Phone:319-221-8570
Mailing Address - Fax:319-221-8575
Practice Address - Street 1:701 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-221-8570
Practice Address - Fax:319-221-8575
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA28419207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0077420Medicaid
IAF04415Medicare UPIN
IA0077420Medicaid