Individual
DR. JOHN P.F.H. VANDERLOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3000 OLD CANTON RD, STE 240, JACKSON, MS 39216-4235
(601) 228-5491
(601) 429-9297
Mailing address
3000 OLD CANTON RD, STE 240, JACKSON, MS 39216-4235
(601) 228-5491
(601) 429-9297
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21905
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00270041
—
MS
01
—
P01402433
RR MEDICARE
MS
Enumeration date
07/02/2010
Last updated
04/06/2020
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