Provider Demographics
NPI:1780741025
Name:VANANTWERP, JAMES FLOYD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FLOYD
Last Name:VANANTWERP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PROMONTORY POINTE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-8001
Mailing Address - Country:US
Mailing Address - Phone:775-232-7408
Mailing Address - Fax:
Practice Address - Street 1:50 PROMONTORY POINTE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-8001
Practice Address - Country:US
Practice Address - Phone:775-232-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6139207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016450Medicaid
05WCGVN27Medicare ID - Type Unspecified