Provider Demographics
NPI:1659334316
Name:VANDERGON, DIRK DENIER (MD)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:DENIER
Last Name:VANDERGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7910
Mailing Address - Fax:615-920-8775
Practice Address - Street 1:1995 ERRECART BLVD.,
Practice Address - Street 2:STE. 204
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8333
Practice Address - Country:US
Practice Address - Phone:775-748-0704
Practice Address - Fax:775-748-2041
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0192207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease