Individual
DR. BRYAN VANDYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2321 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 227-1100
Mailing address
3611 BOULDER CREEK LN, IDAHO FALLS, ID 83406-5114
(919) 475-1161
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
O-1166
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2012
Last updated
01/23/2019
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