Individual
DR. DAVID G VAN DE WYNGAERDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
340 S WILLARD ST, COTTONWOOD, AZ 86326-4126
(928) 639-7960
Mailing address
1200 N BEAVER ST, ATTN: PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
17528
AZ
207X00000X
Orthopaedic Surgery Physician
2013
NC
208600000X
Surgery Physician
201300063
NC
Other
Enumeration date
06/30/2005
Last updated
12/22/2022
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