Healthcare Provider Details

I. General information

NPI: 1932202579
Provider Name (Legal Business Name): JP VANDONGEN, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 9TH ST N #308
NAPLES FL
34102-5627
US

IV. Provider business mailing address

599 9TH ST N #308
NAPLES FL
34102-5627
US

V. Phone/Fax

Practice location:
  • Phone: 239-643-7888
  • Fax: 239-643-4744
Mailing address:
  • Phone: 239-643-7888
  • Fax: 239-643-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME73716
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127276
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN P VAN DONGEN
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 239-643-7888