Provider Demographics
NPI:1609512805
Name:DERGAN, ANDREW S (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:DERGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:712-294-5000
Mailing Address - Fax:712-294-5091
Practice Address - Street 1:2501 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3725
Practice Address - Country:US
Practice Address - Phone:712-294-5000
Practice Address - Fax:712-294-5091
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-12416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine