Provider Demographics
NPI:1932202579
Name:JP VANDONGEN, MD, PA
Entity Type:Organization
Organization Name:JP VANDONGEN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:VAN DONGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-643-7888
Mailing Address - Street 1:599 9TH ST N
Mailing Address - Street 2:#308
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5627
Mailing Address - Country:US
Mailing Address - Phone:239-643-7888
Mailing Address - Fax:239-643-4744
Practice Address - Street 1:599 9TH ST N
Practice Address - Street 2:#308
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5627
Practice Address - Country:US
Practice Address - Phone:239-643-7888
Practice Address - Fax:239-643-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73716207Q00000X
FLME127276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5727534OtherAETNA
01-90398OtherOHC
FL255617100Medicaid
FL255617100Medicaid
FLK5344Medicare PIN