Keith G Vanderzyl Jr MD PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

8612 Issued in AL

Legal business name

KEITH G VANDERZYL JR MD PA

Practice address

218 Hospital Ave
Ste D
Ozark, AL 36360-2064

Phone

(334) 774-5501

Fax

(334) 445-9785

NPI assigned

Aug 17, 2007

Last updated

Jun 5, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Keith Grant Vanderzyl Jr., MD

Title

President

Phone

(334) 774-5501

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1689866121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 HOSPITAL AVE",
            "address_2": "STE D",
            "city": "OZARK",
            "state": "AL",
            "postal_code": "363602064",
            "telephone_number": "334-774-5501",
            "fax_number": "334-445-9785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 HOSPITAL AVE",
            "address_2": "STE D",
            "city": "OZARK",
            "state": "AL",
            "postal_code": "363602064",
            "telephone_number": "334-774-5501",
            "fax_number": "334-445-9785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH G VANDERZYL JR MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-17",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "VANDERZYL",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "GRANT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "334-774-5501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AL",
            "license": "8612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000011034",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000011034",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0196890002",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Ozark, AL
• Providers in Ozark, AL by specialty
• Specialist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; 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.