Individual
JORDAN MICHAEL VAN DE VERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C. PED
Contact information
Practice address
4615 N LAMAR BLVD STE 305, AUSTIN, TX 78751-2357
(512) 476-5110
(512) 476-5178
Mailing address
9901 N CAPITAL OF TEXAS HWY STE 120, AUSTIN, TX 78759-5853
(512) 346-4400
(512) 346-3009
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
Primary
—
TX
Other
Enumeration date
01/20/2021
Last updated
01/20/2021
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