Provider Demographics
NPI:1982931283
Name:LOREN J MOUW MD PC
Entity Type:Organization
Organization Name:LOREN J MOUW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOUW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-221-8570
Mailing Address - Street 1:PO BOX 1718
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-1718
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28419207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty