Healthcare Provider Details

I. General information

NPI: 1427408608
Provider Name (Legal Business Name): DAVID VANDERPOOL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE SUITE 210 BARNETT TOWER
DALLAS TX
75246-2017
US

IV. Provider business mailing address

PO BOX 12485
DALLAS TX
75225-0485
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DAVID VANDERPOOL
Title or Position: PRESIDENT
Credential: MD
Phone: 972-786-0140