Dale Vander Broek, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

02411 Issued in IA

Practice address

2 Deer Run Dr
Pella, IA 50219-1356

Phone

(641) 780-1202

NPI assigned

Mar 16, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400025600000",
    "number": "1386613990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 DEER RUN DR",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191356",
            "telephone_number": "641-780-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DEER RUN DR",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191356",
            "telephone_number": "641-780-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER BROEK",
        "first_name": "DALE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2014-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "02411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110128512",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2067256",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Van Wyk
• Kenneth Wayne Van Wyk, D.C.
• Tereasa L. Van Zee, DO
• Robin L. Vande Voort, MD
• Galyn W Vande Zande, DO
• Nancy A Vander Broek, DO
• Thomas Bernard Vander Linden, RPH.
• Troy Vander Molen, PT
• Kurt Ronald Vander Ploeg, M.D.
• David J Vanderhoff

• Internal Medicine Physician in Pella, IA
• Providers in Pella, IA by specialty
• Internal Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.