Van Andel, Brent J.
Van Andel, Brent J. is an individual health care provider with primary practice located at 711 Bond St El Centro Family Health Bond Clinic, Espanola NM 87532-2729. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Van Andel, Brent J. can be contacted via phone (505) 753-9503.Contact Information
Primary practice address
711 Bond St El Centro Family Health Bond Clinic
Espanola NM 87532-2729
Phone: (505) 753-9503
Fax: (505) 747-1004
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 2004-0159 | New Mexico |
Profile Details
| NPI number | 1770576134 |
|---|---|
| LBN Legal business name | Van Andel, Brent J. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 31st, 2005 |
| Last updated | Jul 1st, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770576134 | NPPES |
| New Mexico | Other | NMA100443 | MEDICARE PTAN |
| New Mexico | MEDICAID | 99750040 | MEDICARE PTAN |
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