Provider Demographics
NPI:1508039629
Name:A. JOHN VANDER ZEE MD, PC
Entity Type:Organization
Organization Name:A. JOHN VANDER ZEE MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:A. JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDER ZEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-366-1549
Mailing Address - Street 1:411 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403
Mailing Address - Country:US
Mailing Address - Phone:319-366-1549
Mailing Address - Fax:319-366-1540
Practice Address - Street 1:411 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2442
Practice Address - Country:US
Practice Address - Phone:319-366-1549
Practice Address - Fax:319-366-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28674208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1086728Medicaid
IA11203Medicare PIN
IA1086728Medicaid