Individual
MISS JONATHAN S. VORDERMARK
Active
Individual
MISS JONATHAN S. VORDERMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
F6156
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87990Z
HMO BLUE
TX
01
—
89C198
BC/BS
TX
05
—
U5622
—
NM
Enumeration date
10/03/2006
Last updated
07/13/2007
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