Active NPI
Harry Ralph Vanderwal Jr., MD
- Pediatrics Physician
- Sandpoint, ID
National Provider Identifier
1881803971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- M 9823
- Practice address
- 420 N 2ND Ave
Ste 100
Sandpoint, ID 83864-1565 - Phone
- (208) 265-2242
- Fax
- (208) 265-8214
- NPI assigned
- May 22, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | M 9823 | ID | Primary |
Addresses
Primary practice location
420 N 2ND Ave
Ste 100
Sandpoint, ID 83864-1565
Mailing address
420 N 2ND Ave
Ste 100
Sandpoint, ID 83864-1552
Phone (208) 265-2242
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M 9823 | ID | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881803971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 N 2ND AVE",
"address_2": "STE 100",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838641552",
"telephone_number": "208-265-2242",
"fax_number": "208-265-8214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 N 2ND AVE",
"address_2": "STE 100",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838641565",
"telephone_number": "208-265-2242",
"fax_number": "208-265-8214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERWAL",
"first_name": "HARRY",
"middle_name": "RALPH",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "ID",
"license": "M 9823",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandpoint, ID
- Valley Vista Care Corporation (Vista Therapy of Sandpoint)
- Valley Vista Care Corporation (Valley Vista Care Center of Sandpoint)
- Cameron Cory Van Den Berg, DC
- Christian Vanderford, PT
- Echo T Vanderwal, PA
- Joseph Anthony Velazquez, LMFT
- Kimberley Lorraine Velazquez, MSW
- Henry L Verdugo, LCSW
- Viva Enterprises (Sandpoint Optometry & Thomas M Wiley OD)
- Andrew Benjamin Vizcarra, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.