Healthcare Provider Details

I. General information

NPI: 1104806280
Provider Name (Legal Business Name): NATHAN S HAHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

IV. Provider business mailing address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-5000
  • Fax: 319-272-5264
Mailing address:
  • Phone: 319-272-5000
  • Fax: 319-272-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2004010782
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-43977
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: