Provider Demographics
NPI:1275518136
Name:VANDERSLOOT, JAMES ALAN (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:VANDERSLOOT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:ALAN
Other - Last Name:VANDERSLOOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:320 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2922
Mailing Address - Country:US
Mailing Address - Phone:509-525-5010
Mailing Address - Fax:509-522-9448
Practice Address - Street 1:320 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2922
Practice Address - Country:US
Practice Address - Phone:509-525-5010
Practice Address - Fax:509-522-9448
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001762207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG80196Medicare UPIN