Individual
MISS JONATHAN S. VORDERMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3502 9TH ST, SUITE 260, LUBBOCK, TX 79415-3300
(806) 743-1810
(806) 743-1335
Mailing address
PO BOX 5865, LUBBOCK, TX 79408-5865
(806) 743-2898
(806) 743-2787
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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