Individual
DR. THEN ETHAN VAN TONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1201 PENN AVE, DES MOINES, IA 50316-2339
(515) 266-1000
(515) 266-1824
Mailing address
1201 PENN AVE, DES MOINES, IA 50316-2339
(515) 266-1000
(515) 266-1824
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4475
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447578992
—
IA
01
—
P01242999
RR MEDICARE
IA
Enumeration date
05/08/2010
Last updated
01/20/2014
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