Healthcare Provider Details

I. General information

NPI: 1720075658
Provider Name (Legal Business Name): JAMES P VANGELDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON ST SUITE 500
HOLLYWOOD FL
33021-8259
US

IV. Provider business mailing address

3700 WASHINGTON ST SUITE 500
HOLLYWOOD FL
33021-8259
US

V. Phone/Fax

Practice location:
  • Phone: 954-962-0338
  • Fax: 954-962-2357
Mailing address:
  • Phone: 954-962-0338
  • Fax: 954-962-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME22201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: