Basic Information
| Provider Information | |||||||||
| NPI: | 1982999728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANWAGENBERG | ||||||||
| FirstName: | FRANS | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565333388 | ||||||||
| FaxNumber: | 2568016905 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 SIVLEY RD SW STE 300 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565365594 | ||||||||
| FaxNumber: | 2565333379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2011 | ||||||||
| LastUpdateDate: | 08/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | BP10041442 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | 38537 | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.