Individual
JOHN M VANDEREN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
613 23RD ST, STE 230, ASHLAND, KY 41101-2876
(606) 324-4745
(606) 324-4941
Mailing address
PO BOX 2379, ASHLAND, KY 41105-2379
(606) 324-4745
(606) 324-4941
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
27105
KY
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
27105
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000065461
ANTHEM BCBS
KY
05
—
2138252
—
OH
05
—
6020006000
—
WV
05
—
64271059
—
KY
Enumeration date
10/19/2005
Last updated
02/28/2014
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