Individual
DAN VANDERIET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 MARIYANA ST, GALLUP, NM 87301-5635
(505) 726-8360
Mailing address
2401 MARIYANA ST, GALLUP, NM 87301-5635
(505) 726-8360
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301051395
MI
Other
Enumeration date
12/17/2013
Last updated
12/17/2013
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