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NPI Code Detail

MEDICARE: LARRY B VANDERWOUDE MD

MEDICARE: LARRY B VANDERWOUDE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2500SD

General Provider Information

NPI Number : 1306892757
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY B VANDERWOUDE MD
Provider Business Mailing Address
First Line : 2701 S KIWANIS AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57105-4252
Country : US
Telephone Number : 605-328-9100
Fax Number : 605-328-9101
Provider Business Practice Location Address
First Line : 2701 S KIWANIS AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57105-4252
Country : US
Telephone Number : 605-328-9100
Fax Number : 605-328-9101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 05/08/2008

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Directions to “ LARRY B VANDERWOUDE MD” Practice Location

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