Individual
DR. BRENT J. VAN ANDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
711 BOND ST, EL CENTRO FAMILY HEALTH BOND CLINIC, ESPANOLA, NM 87532-2729
(505) 753-9503
(505) 747-1004
Mailing address
PO BOX 158, EL CENTRO FAMILY HEALTH, ESPANOLA, NM 87532-0158
(505) 753-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2004-0159
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99750040
—
NM
01
—
NMA100443
MEDICARE PTAN
NM
Enumeration date
08/31/2005
Last updated
07/01/2013
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