Individual
JON JAY VAN DER VEER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4189
IA
207R00000X
Internal Medicine Physician
R8668
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649408808
—
IA
01
—
P01140959
RR MEDICARE
IA
Enumeration date
06/26/2009
Last updated
11/06/2023
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