Individual
DALE VANDER BROEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02411
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110128512
RAILROAD MEDICARE
IA
05
—
2067256
—
IA
Enumeration date
03/16/2006
Last updated
05/14/2014
Update your record
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