Provider Demographics
NPI:1730175795
Name:MOREHOUSE, DAN LEE (MD RVT)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:LEE
Last Name:MOREHOUSE
Suffix:
Gender:M
Credentials:MD RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2742
Mailing Address - Country:US
Mailing Address - Phone:641-243-2154
Mailing Address - Fax:641-243-2161
Practice Address - Street 1:1306 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2742
Practice Address - Country:US
Practice Address - Phone:641-243-2154
Practice Address - Fax:641-243-2161
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA327222086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2184135Medicaid
IAG88108Medicare UPIN
IA0355010044Medicare NSC
IAI12575Medicare ID - Type Unspecified