Healthcare Provider Details

I. General information

NPI: 1891154530
Provider Name (Legal Business Name): THOMAS CARL VANHOOSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NE 139TH ST STE 110
VANCOUVER WA
98686-2719
US

IV. Provider business mailing address

2525 NE 139TH ST STE 110
VANCOUVER WA
98686-2719
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.MD.61691088
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number54784
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.MD.61691088
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: