Healthcare Provider Details

I. General information

NPI: 1710481411
Provider Name (Legal Business Name): JAMES EDWARD VANDRUFF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W CEDAR LN STE A
PAYSON AZ
85541-5417
US

IV. Provider business mailing address

3815 E BELL RD STE 4500
PHOENIX AZ
85032-2171
US

V. Phone/Fax

Practice location:
  • Phone: 928-472-4675
  • Fax: 928-472-3431
Mailing address:
  • Phone: 602-633-3848
  • Fax: 602-633-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO5915
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number008954
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: