Individual
HARRY RALPH VANDERWAL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 N 2ND AVE, STE 100, SANDPOINT, ID 83864-1565
(208) 265-2242
(208) 265-8214
Mailing address
420 N 2ND AVE, STE 100, SANDPOINT, ID 83864-1552
(208) 265-2242
(208) 265-8214
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M 9823
ID
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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