MEDICARE: DR. JAMES P VANGELDER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	ME22201	FL

General Provider Information

NPI Number	:	1720075658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES P VANGELDER M.D.

Provider Business Mailing Address
First Line	:	3700 WASHINGTON ST
Second Line	:	SUITE 500
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8259
Country	:	US
Telephone Number	:	954-962-0338
Fax Number	:	954-962-2357

Provider Business Practice Location Address
First Line	:	3700 WASHINGTON ST
Second Line	:	SUITE 500
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8259
Country	:	US
Telephone Number	:	954-962-0338
Fax Number	:	954-962-2357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	12/11/2009

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