Healthcare Provider Details

I. General information

NPI: 1275617672
Provider Name (Legal Business Name): JAMES VANDERPLOEG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NASA PKWY # 1
HOUSTON TX
77058-3607
US

IV. Provider business mailing address

2101 NASA PKWY # 1
HOUSTON TX
77058-3607
US

V. Phone/Fax

Practice location:
  • Phone: 281-483-7786
  • Fax:
Mailing address:
  • Phone: 281-483-7786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberF7653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: