Provider Demographics
NPI:1578678579
Name:VASSALL, ALFORD NATHANIEL JR (MD)
Entity Type:Individual
Prefix:
First Name:ALFORD
Middle Name:NATHANIEL
Last Name:VASSALL
Suffix:JR
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 1:939 CAROLINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3909
Mailing Address - Country:US
Mailing Address - Phone:360-565-0999
Mailing Address - Fax:360-452-7303
Practice Address - Street 1:939 CAROLINE ST STE A
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3909
Practice Address - Country:US
Practice Address - Phone:360-655-0999
Practice Address - Fax:360-452-7303
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83-330207VX0000X
WAMD60062958207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32D0873765Medicare ID - Type Unspecified
NMD43340Medicare UPIN
NM201010306Medicaid