Individual
DONALD T VAN DE WATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 MERCY DR, ALEGENT MERCY HOSPITAL DEPT OF RADIOLOGY, COUNCIL BLUFFS, IA 51503-3128
(712) 328-5100
Mailing address
PO BOX 4460, OMAHA, NE 68104
(866) 491-5807
(913) 491-0411
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
18576
NE
2085R0202X
Diagnostic Radiology Physician
21318
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03103
NEBRASKA BCBS
—
05
—
0537282
—
IA
05
—
1310532
—
IA
01
—
1600329
UHC SHARE ALLIANCE
—
01
—
1600507
UHC SHARE ALLIANCE
—
01
—
19065
IOWA BCBS
—
01
—
24705
MIDLANDS
—
05
—
3537282
—
IA
05
—
4537282
—
IA
05
—
5537282
—
IA
01
—
AV9724039
IA CONTROLLED SUBSTANCE
—
Enumeration date
06/20/2006
Last updated
03/07/2023
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