Healthcare Provider Details

I. General information

NPI: 1225123912
Provider Name (Legal Business Name): JOHN ARTHUR VANOSTENBRIDGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5834 BERRYHILL RD
MILTON FL
32570-8275
US

IV. Provider business mailing address

5834 BERRYHILL RD
MILTON FL
32570-8275
US

V. Phone/Fax

Practice location:
  • Phone: 850-623-5437
  • Fax: 850-626-7803
Mailing address:
  • Phone: 850-623-5437
  • Fax: 850-626-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME55036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: