| Doctor Name: | DR. STEVEN CRAIG VANDER WAAL |
| NPI Number: | 1023190220 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 13959 |
| Business Practice Address: | 3619 Highway 101 N Gearhart, OR - 971384321 |
| Business Phone Number: | 5037383832 |
| Business Fax Number: | 5037383466 |
| Mailing Address: | 3619 Highway 101 N, GEARHART |
| State: | OR |
| Postal Code: | 971384321 |
| Phone Number: | 5037383832 |
| Fax Number: | 5037383466 |
| NPI Enumeration Date: | 10/19/2006 |
| NPI Last Update Date: | 05/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 13959 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |