MEDICARE: ARANSAS SPINE CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		TX

General Provider Information

NPI Number	:	1548682529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARANSAS SPINE CARE

Provider Business Mailing Address
First Line	:	3757 FM 1781
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-7613
Country	:	US
Telephone Number	:	214-952-3018
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E MIMOSA ST
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-4151
Country	:	US
Telephone Number	:	214-952-3018
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK YELDERMAN
Credential	:	M.D.
Telephone Number	:	214-952-3018

Provider Enumeration Date	:	01/10/2014
Last Update Date	:	01/10/2014

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Directions to “ARANSAS SPINE CARE ” Practice Location

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