Individual
DUSTIN B. MANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8196 WALNUT HILL LN STE 100, DALLAS, TX 75231-7001
(214) 739-4175
(214) 345-7684
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-0813
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
M8157
TX
207VX0201X
Gynecologic Oncology Physician
Primary
M8157
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213145003
—
TX
05
—
213145004
—
TX
01
—
BP1-0026457
INSTITUTIONAL PERMIT
—
01
—
P01752676
RAILROAD
TX
Enumeration date
06/07/2007
Last updated
11/15/2023
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