Provider Demographics
NPI:1083729719
Name:VAN DAM, DAVID KURT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KURT
Last Name:VAN DAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 E PINCHOT AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7020
Mailing Address - Country:US
Mailing Address - Phone:727-772-3254
Mailing Address - Fax:
Practice Address - Street 1:6313 E PINCHOT AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7020
Practice Address - Country:US
Practice Address - Phone:727-772-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5693207L00000X
NMMD2005-0411207L00000X
VA0101238520207L00000X
AZ34412207L00000X
NY235509-1207L00000X
FLME94752207L00000X
NJ25MA07971100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology