Individual
RUSSELL S VANDERWILDE
Active
Individual
RUSSELL S VANDERWILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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