Provider Demographics
NPI:1225123912
Name:VANOSTENBRIDGE, JOHN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:VANOSTENBRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5834 BERRYHILL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8275
Mailing Address - Country:US
Mailing Address - Phone:850-623-5437
Mailing Address - Fax:850-626-7803
Practice Address - Street 1:5834 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8275
Practice Address - Country:US
Practice Address - Phone:850-623-5437
Practice Address - Fax:850-626-7803
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55036208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06173000Medicaid
FLE78017Medicare UPIN
FL06173000Medicaid