Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | POR330 | FL |
N | 222Z00000X | Podiatrist | POR330 | FL |
Y | 224P00000X | Prosthetist | POR330 | FL |
NPI | 1487051991 |
---|---|
Provider Name | Lori Vanderhoof |
First Address | Panama City Beach, FL 32407-0270 |
Second Address | Panama City, FL 32405-4411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2014 |
Last Update Date | 29/11/2017 |