Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 11542 | MS |
NPI | 1245277573 |
---|---|
Provider Name | Dr. Robert Vanuden |
First Address | Mccomb, MS 39649-0490 |
Second Address | Mccomb, MS 39648-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 14/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00095703 | (05) | MS |