Individual
DR. DAVID THEODORE VANDERMOLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 GREENWOOD RD, SUITE A, SHREVEPORT, LA 71103-4010
(318) 841-5800
(318) 841-5817
Mailing address
2401 GREENWOOD RD, SUITE A, SHREVEPORT, LA 71103-4010
(318) 841-5800
(318) 841-5817
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
12977R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1551767
—
LA
Enumeration date
07/20/2006
Last updated
04/08/2020
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