Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | LV045322 | MI |
NPI | 1013072198 |
---|---|
Provider Name | Dr. Larry Marvin Vanderplas |
First Address | Battle Creek, MI 49015-9393 |
Second Address | Battle Creek, MI 49015-9393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0831635 | PHP (01) | MI |
3158190 | (05) | MI |
383224959101 | (05) | MI |
B45512 | (02) | MI |
LV045322 | STATE LICENSE NUMBER (01) | MI |