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General NPI Number Information
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NPI Number | 1225027907
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Entity Type | Individual
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Provider Name | MAHLON VANDELDEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 1000 W NIFONG BLVD BUILDING 3, SUITE 100
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City | COLUMBIA
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State | MO
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Zip | 65203-5615
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Country | US
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Telephone | 573-214-2000
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Fax | 573-214-2042
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Provider Business Mailing Address
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Address Line | 1000 W NIFONG BLVD BUILDING 3, SUITE 100
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City | COLUMBIA
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State | MO
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Zip | 65203-5615
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Country | US
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Telephone | 573-214-2000
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Fax | 573-214-2042
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 01048581A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 34110
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 101110
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License Number State | MO
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