Provider Demographics
NPI:1093792129
Name:DEJONG, VAUN W (DO)
Entity Type:Individual
Prefix:
First Name:VAUN
Middle Name:W
Last Name:DEJONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 PLEASANT ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1414
Mailing Address - Country:US
Mailing Address - Phone:515-243-8842
Mailing Address - Fax:515-282-9806
Practice Address - Street 1:1212 PLEASANT ST
Practice Address - Street 2:SUITE 405
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1414
Practice Address - Country:US
Practice Address - Phone:515-243-8842
Practice Address - Fax:515-282-9806
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3672207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1093792129Medicaid
IA1093792129Medicaid
IAI16615Medicare PIN