Provider Demographics
NPI:1861401572
Name:VANGORP, DAVID L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:VANGORP
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 1:920 SOUTH OAK STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-9506
Mailing Address - Country:US
Mailing Address - Phone:641-648-7100
Mailing Address - Fax:641-648-7095
Practice Address - Street 1:920 SOUTH OAK STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-9506
Practice Address - Country:US
Practice Address - Phone:641-648-7100
Practice Address - Fax:641-648-7095
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3214155Medicaid
IA3214155Medicaid
IAA02392Medicare UPIN