Individual
DR. ELMER H VANDYKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3131 BRIANNA BLVD, SEDALIA, MO 65301-2285
(660) 826-1381
(660) 827-3001
Mailing address
3131 BRIANNA BLVD, SEDALIA, MO 65301-2285
(660) 826-1381
(660) 827-3001
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
27057
MO
207VG0400X
Gynecology Physician
Primary
27057
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01881013
BLUE CROSS BLUES SHIELD
MO
05
—
200437408
—
MO
Enumeration date
05/15/2006
Last updated
04/19/2021
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