Provider Demographics
NPI:1952470130
Name:VEGTER, GAIL DUANE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GAIL
Middle Name:DUANE
Last Name:VEGTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 530TH ST LOT 45
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-7260
Mailing Address - Country:US
Mailing Address - Phone:906-282-1668
Mailing Address - Fax:
Practice Address - Street 1:1251 W CEDAR LOOP
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1572
Practice Address - Country:US
Practice Address - Phone:712-225-6918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001686363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant