Provider Demographics
NPI:1649408808
Name:VAN DER VEER, JON JAY (DO)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:JAY
Last Name:VAN DER VEER
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 1:7300 WESTOWN PKWY STE 330
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2527
Mailing Address - Country:US
Mailing Address - Phone:515-650-4370
Mailing Address - Fax:
Practice Address - Street 1:7300 WESTOWN PKWY STE 330
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2527
Practice Address - Country:US
Practice Address - Phone:515-650-4370
Practice Address - Fax:515-650-4373
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8668207R00000X
IA4189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01140959OtherRR MEDICARE
IA1649408808Medicaid
IAP01140959OtherRR MEDICARE