Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A97490 | CA |
N | 111NI0900X | Internist | A97490 | CA |
Y | 207RX0202X | Medical Oncology | A97490 | CA |
NPI | 1083801450 |
---|---|
Provider Name | Dr. Ari M. Vanderwalde |
First Address | Germantown, TN 38138-1762 |
Second Address | Germantown, TN 38138-1762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2007 |
Last Update Date | 07/03/2016 |