Provider Demographics
NPI:1548849292
Name:VANDER STOEP, BRANDON LEE (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:VANDER STOEP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DOON
Mailing Address - State:IA
Mailing Address - Zip Code:51235-7764
Mailing Address - Country:US
Mailing Address - Phone:712-470-6649
Mailing Address - Fax:
Practice Address - Street 1:1000 LINCOLN CIR SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1836
Practice Address - Country:US
Practice Address - Phone:712-737-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-50921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine