Individual
RUSSELL S VANDERWILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 W 5TH AVE, SUITE 400, SPOKANE, WA 99204-2715
(509) 344-2663
(509) 624-9179
Mailing address
601 W 5TH AVE, SUITE 400, SPOKANE, WA 99204-2715
(509) 344-2663
(509) 624-9179
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD00030742
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010002357
REGENCE BS OF IDAHO
ID
05
—
003297000
—
ID
05
—
1083047
—
WA
01
—
200016187
RR MEDICARE
WA
01
—
3283
GROUP HEALTH NW
WA
01
—
3780VA
ASURIS NW HEALTH
WA
01
—
379109600
OWCP
WA
01
—
42091
DEPT OF LABOR & INDUSTRIE
WA
01
—
8919653
CRIME VICTIMS
WA
01
—
K6484
BLUE CROSS OF IDAHO
ID
Enumeration date
03/14/2006
Last updated
03/11/2008
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