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General NPI Number Information
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NPI Number | 1144358177
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Entity Type | Organization
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Legal Business Name | COREY VANDE ZANDSCHULP MD PC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 06/25/2021
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Provider Practice Location Address
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Address Line | 4103 MERCANTILE DR
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-2556
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Country | US
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Telephone | 503-850-9940
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Fax | 877-533-6717
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Provider Business Mailing Address
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Address Line | 4103 MERCANTILE DR
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-2556
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Country | US
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Telephone | 503-850-9940
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Fax | 877-533-6717
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Authorized Official
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Title or Position | OWNER
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Name | DR. COREY VANDE ZANDSCHULP
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Credential | MD
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Telephone | 503-850-9940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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