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General NPI Number Information
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NPI Number | 1881885960
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Entity Type | Organization
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Legal Business Name | DOUGLAS L. VANDERBILT, M.D. ,P.C.
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 721 GLENWOOD DR MEMORIAL MEDICAL BLDG., WEST SUITE 470
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City | CHATTANOOGA
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State | TN
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Zip | 37404-1106
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Country | US
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Telephone | 423-892-9208
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Fax | 423-892-9212
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Provider Business Mailing Address
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Address Line | PO BOX 23371
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City | CHATTANOOGA
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State | TN
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Zip | 37422-3371
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Country | US
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Telephone | 423-892-9208
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Fax | 423-892-9212
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS L VANDERBILT
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Credential | M.D.
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Telephone | 423-892-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 7995
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License Number State | TN
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