Individual
JOHN C VANDOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
525 COUCH AVE, KIRKWOOD, MO 63122-5536
(314) 966-1500
(314) 966-1681
Mailing address
1836 LACKLAND HILL PKWY, ATTENTION: CREDENTIALING DEPARTMENT, SAINT LOUIS, MO 63146-3572
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2004001492
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00273311
RR MEDICARE
MO
Enumeration date
06/07/2006
Last updated
11/11/2008
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