Provider Demographics
NPI:1316049075
Name:VANGAASBEEK, GARY LEE (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:VANGAASBEEK
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 1:266 ATWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112
Mailing Address - Country:US
Mailing Address - Phone:812-738-4111
Mailing Address - Fax:812-738-6166
Practice Address - Street 1:266 ATWOOD ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112
Practice Address - Country:US
Practice Address - Phone:812-738-4111
Practice Address - Fax:812-738-6166
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050587A207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Not Answered207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A60038Medicare UPIN
IN189960Medicare ID - Type Unspecified