Healthcare Provider Details

I. General information

NPI: 1982931283
Provider Name (Legal Business Name): LOREN J MOUW MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 10TH ST SE
CEDAR RAPIDS IA
52403-1251
US

IV. Provider business mailing address

PO BOX 1718
CEDAR RAPIDS IA
52406-1718
US

V. Phone/Fax

Practice location:
  • Phone: 319-221-8570
  • Fax: 319-221-8575
Mailing address:
  • Phone: 319-221-8570
  • Fax: 319-221-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number28419
License Number StateIA

VIII. Authorized Official

Name: DR. LOREN J MOUW
Title or Position: PRESIDENT
Credential: MD
Phone: 319-221-8570