Steven Craig Vander Waal, M.D.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

13959 Issued in OR

Practice address

3619 Highway 101 N
Gearhart, OR 97138-4321

Phone

(503) 738-3832

Fax

(503) 738-3466

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400803200000",
    "number": "1023190220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3619 HIGHWAY 101 N",
            "city": "GEARHART",
            "state": "OR",
            "postal_code": "971384321",
            "telephone_number": "503-738-3832",
            "fax_number": "503-738-3466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3619 HIGHWAY 101 N",
            "city": "GEARHART",
            "state": "OR",
            "postal_code": "971384321",
            "telephone_number": "503-738-3832",
            "fax_number": "503-738-3466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER WAAL",
        "first_name": "STEVEN",
        "middle_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2014-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "OR",
            "license": "13959",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OR",
            "license": "13959",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Bernard Schell, MPT
• Holly Slabbert, OTR/L
• Stephanie R White DMD LLC
• Delores Swigert Sullivan, LCSW
• Michelle G Vander Waal, PMHNP
• Patricia Veith, PT
• Cheri Elaine Walter, LMT
• Angela Walther, LCSW
• Stephanie R White, DMD LLC
• Theodosia Ann Woods, D.C.

• Medical Specialty Clinic/Center in Gearhart, OR
• Providers in Gearhart, OR by specialty
• Medical Specialty Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.