Provider Demographics
NPI:1841289311
Name:PAUSTIAN, DAVID LOWELL (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LOWELL
Last Name:PAUSTIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-9506
Mailing Address - Country:US
Mailing Address - Phone:641-648-7000
Mailing Address - Fax:641-648-7019
Practice Address - Street 1:920 S OAK ST
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-9506
Practice Address - Country:US
Practice Address - Phone:641-648-7000
Practice Address - Fax:641-648-7019
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42083208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30097100Medicaid
IA0499889Medicaid
IAI18676Medicare PIN
IA161302Medicare Oscar/Certification
H21584Medicare UPIN
WI30097100Medicaid
IA0499889Medicaid