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General NPI Number Information
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NPI Number | 1154326544
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Entity Type | Individual
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Provider Name | RODNEY KENT VAN ANDEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 05/14/2014
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Provider Practice Location Address
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Address Line | 3203 S MAIN ST
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City | LINDALE
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State | TX
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Zip | 75771-7727
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Country | US
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Telephone | 903-266-4000
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Fax | 903-882-7751
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Provider Business Mailing Address
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Address Line | PO BOX 5500
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City | TYLER
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State | TX
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Zip | 75712-5500
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Country | US
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Telephone | 903-324-6450
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Fax | 903-593-7569
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L7909
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | L7909
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License Number State | TX
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