Healthcare Provider Details

I. General information

NPI: 1043497258
Provider Name (Legal Business Name): HARVEY G VAN DELL, MD, PA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 LONG PRAIRIE RD SUITE E
FLOWER MOUND TX
75022-4845
US

IV. Provider business mailing address

2980 LONG PRAIRIE RD SUITE E
FLOWER MOUND TX
75022-4845
US

V. Phone/Fax

Practice location:
  • Phone: 972-899-9787
  • Fax: 972-899-9786
Mailing address:
  • Phone: 972-899-9787
  • Fax: 972-899-9786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberK8697
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number536369
License Number StateTX

VIII. Authorized Official

Name: DR. HARVEY GUYTON VAN DELL IV
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 972-899-9787