Provider Demographics
NPI:1366902652
Name:VANDER VOORT, WYATT DANIEL
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:DANIEL
Last Name:VANDER VOORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4680 Y STREET
Mailing Address - Street 2:SUITE 3800
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-2807
Mailing Address - Fax:916-734-7904
Practice Address - Street 1:4680 Y STREET
Practice Address - Street 2:SUITE 1700
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-2700
Practice Address - Fax:916-703-5074
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.150344207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery