Provider Demographics
NPI:1457391138
Name:VANDERPOOL, PATRICIA A (DPM)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7517 DOUGLAS AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3075
Mailing Address - Country:US
Mailing Address - Phone:515-252-1550
Mailing Address - Fax:515-252-8886
Practice Address - Street 1:7517 DOUGLAS AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3075
Practice Address - Country:US
Practice Address - Phone:515-252-1550
Practice Address - Fax:515-252-8886
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00590213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3128140Medicaid
IAU56894Medicare UPIN
IA1250970001Medicare NSC
IA48227Medicare PIN