Healthcare Provider Details

I. General information

NPI: 1386824019
Provider Name (Legal Business Name): NATHAN A. VERMEDAHL, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E 16TH ST
DALHART TX
79022-4802
US

IV. Provider business mailing address

206 E 16TH ST
DALHART TX
79022-4802
US

V. Phone/Fax

Practice location:
  • Phone: 806-244-5668
  • Fax: 806-244-5912
Mailing address:
  • Phone: 806-244-5668
  • Fax: 806-244-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM3105
License Number StateTX

VIII. Authorized Official

Name: DR. NATHAN A. VERMEDAHL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 806-244-5668