Individual
JOHN A. VANDE WAA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, PHD
Contact information
Practice address
2451 FILLINGIM ST, MASTIN BLDG, MOBILE, AL 36617-2238
(251) 470-5890
(251) 471-7925
Mailing address
PO BOX 40480, MOBILE, AL 36640-0480
(251) 470-5890
(251) 471-7925
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
DO-401
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000023305
—
AL
05
—
00121697
—
MS
05
—
009935162
—
AL
05
—
009975140
—
AL
05
—
1503762
—
FL
05
—
255961700
—
FL
01
—
51023305
BCBS
AL
01
—
51505303
BCBS
AL
01
—
51532424
BCBS
AL
01
—
51543343
BCBS - FILLINGIM ST
AL
01
—
92-10077
UNITED HEALTHCARE
AL
Enumeration date
06/07/2006
Last updated
05/12/2015
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