Provider Demographics
NPI:1265403216
Name:VAN OORT, TERRY DALE (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:DALE
Last Name:VAN OORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SE RICHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-3650
Mailing Address - Country:US
Mailing Address - Phone:515-229-0310
Mailing Address - Fax:
Practice Address - Street 1:302 SW WALNUT ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-3042
Practice Address - Country:US
Practice Address - Phone:515-229-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-29
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0006775Medicaid
IA18174OtherBC/BS OF IOWA
080175023OtherRAILROAD MEDICARE
IA3006775Medicaid
IA70990OtherWELLMARK BLUE SHIELD
IA0006775Medicaid
IAAO1580Medicare UPIN