Provider Demographics
NPI:1467696310
Name:VANGUILDER, KAMIN BETH (MD)
Entity Type:Individual
Prefix:MS
First Name:KAMIN
Middle Name:BETH
Last Name:VANGUILDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:LOVELOCK
Mailing Address - State:NV
Mailing Address - Zip Code:89419-0661
Mailing Address - Country:US
Mailing Address - Phone:775-273-2918
Mailing Address - Fax:775-273-5095
Practice Address - Street 1:855 6TH ST.
Practice Address - Street 2:
Practice Address - City:LOVELOCK
Practice Address - State:NV
Practice Address - Zip Code:89419-0661
Practice Address - Country:US
Practice Address - Phone:775-273-2918
Practice Address - Fax:775-273-5095
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113185207Q00000X
NV14457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN