Provider Demographics
NPI:1255432431
Name:VAN VOOREN, JAMES S (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:VAN VOOREN
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2924
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:
Practice Address - Street 1:UFP BETHESDA CLINIC
Practice Address - Street 2:580 RICE STREET
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103
Practice Address - Country:US
Practice Address - Phone:651-227-6551
Practice Address - Fax:651-665-0684
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN35987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8F852VAOtherBLUE CROSS BLUE SHIELD
E36226Medicare UPIN
MN080011819Medicare ID - Type Unspecified