Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JOHNNY RAY VANDIVER, PA
ActiveJOHNNY RAY VANDIVER, PA is a Physician Assistant healthcare provider located in JOINT BASE LEWIS MCHORD, Washington. NPI 1629059126 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · JOINT BASE LEWIS MCHORD, WA
Registration Details
- NPI Number
- 1629059126
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Nov 10, 2005 (20.739698387552 yrs)
- Last Updated
- Nov 7, 2012
Practice Information
- Address
-
12233 24TH STREETJOINT BASE LEWIS MCHORD, WA, 98433Browse WA providers · Browse ZIP 98433
- Phone
- 2534775734
- Primary Specialty
-
Physician Assistant
363A00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.