Provider Demographics
NPI:1457536690
Name:VERMEULEN, WALTER JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JAN
Last Name:VERMEULEN
Suffix:
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:PO BOX 5336
Mailing Address - Street 2:TUTUILA SLEEP CLINIC
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-5336
Mailing Address - Country:US
Mailing Address - Phone:684-699-8336
Mailing Address - Fax:
Practice Address - Street 1:5336 HIGHWAY 1 AVE.
Practice Address - Street 2:TUTUILA SLEEP CLINIC
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-699-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS2015-A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist