Individual
DR. MARK ETHAN VANNORDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
200 E 8TH ST, LARNED, KS 67550-2602
(620) 285-6041
(620) 285-6194
Mailing address
200 E 8TH ST, LARNED, KS 67550-2602
(620) 285-6041
(620) 285-6194
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0530418
KS
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
05-30418
KS
207Q00000X
Family Medicine Physician
Primary
05-30418
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107025
BLUE SHIELD
KS
05
—
200252510C
—
KS
05
—
200252510F
—
KS
Enumeration date
05/16/2006
Last updated
04/01/2020
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