Individual
DR. MARK LEWIS VANDEWALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 W NIFONG BLVD, SUITE 2B, COLUMBIA, MO 65203-6804
(573) 446-7000
(573) 445-1000
Mailing address
601 W NIFONG BLVD, SUITE 2B, COLUMBIA, MO 65203-6804
(573) 446-7000
(573) 445-1000
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
R2F17
MO
Other
Enumeration date
10/16/2007
Last updated
10/16/2007
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