Basic Information
| Provider Information | |||||||||
| NPI: | 1275518136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANDERSLOOT | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VANDERSLOOT | ||||||||
| OtherFirstName: | JAMES | ||||||||
| OtherMiddleName: | ALAN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 320 W WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993622922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095255010 | ||||||||
| FaxNumber: | 5095229448 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 W WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993622922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095255010 | ||||||||
| FaxNumber: | 5095229448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 10/16/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | OP00001762 | WA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.