Provider Demographics
NPI:1639160898
Name:VANGORP, PAUL E (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:VANGORP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:E
Other - Last Name:VANGORP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20 9TH ST SE
Mailing Address - Street 2:CENTRACARE HEALTH SYSTEM LONG PRAIRIE
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-1404
Mailing Address - Country:US
Mailing Address - Phone:320-732-2131
Mailing Address - Fax:320-732-6913
Practice Address - Street 1:20 9TH ST SE
Practice Address - Street 2:CENTRACARE HEALTH SYSTEM LONG PRAIRIE
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-1404
Practice Address - Country:US
Practice Address - Phone:320-732-2131
Practice Address - Fax:320-732-6913
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMPOtherMMSI
COMPOtherONE HEALTH PLAN/GREATWEST
HP23039OtherHEALTH PARTNERS
1006861OtherPREFERRED ONE
116872OtherU-CARE
0106463OtherMEDICA HEALTH PLANS
499762000OtherMEDICAL ASSISTANCE
54Q37VAOtherBLUE CROSS BLUE SHIELD
784038OtherFIRST HEALTH PLAN
806968OtherARAZ GROUP/AMERICAS PPO
COMPOtherCHAMPUS
D49032Medicare UPIN
COMPOtherONE HEALTH PLAN/GREATWEST
COMPOtherMMSI