Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 01050587A | IN |
N | 207VX0000X | Obstetrician | 01050587A | IN |
NPI | 1316049075 |
---|---|
Provider Name | Gary Lee Vangaasbeek |
First Address | Corydon, IN 47112 |
Second Address | Corydon, IN 47112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A60038 | (02) |