Basic Information
| Provider Information | |||||||||
| NPI: | 1710203401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANOSDOL | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | DEAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 FAIRMONT BLVD | ||||||||
| Address2: | ATTN MSS | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577017375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057558107 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1445 NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | SPEARFISH | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577831552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056444170 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2010 | ||||||||
| LastUpdateDate: | 01/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 9896 | SD | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.