Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101047689 | VA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 0101047689 | VA |
NPI | 1720054919 |
---|---|
Provider Name | John William Vanmanen |
First Address | North Chesterfield, VA 23225-4067 |
Second Address | Richmond, VA 23294 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6451772 | (05) | VA |
F10493 | (02) |