Provider Demographics
NPI:1235422924
Name:VANDERLOOP, ASHLEY IRENE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:IRENE
Last Name:VANDERLOOP
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:835 E LAMAR BLVD
Mailing Address - Street 2:#281
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-3504
Mailing Address - Country:US
Mailing Address - Phone:810-869-3663
Mailing Address - Fax:
Practice Address - Street 1:575 RIVERGATE UNIT 105
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-259-3154
Practice Address - Fax:970-828-1666
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00382213ES0103X
CO819213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery