Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2405 | SD |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 2405 | SD |
NPI | 1134126121 |
---|---|
Provider Name | Robert E Vandemark |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Sioux Falls, SD 57104-4647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 10/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6400314 | (05) | SD |
D28534 | (02) |