Organization
COASTAL BEND FAMILY MEDICINE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID LOYD VANDERHEIDEN D.O. (PRESIDENT)
(361) 993-1747
Entity
Organization
Contact information
Practice address
4818 HOLLY RD, SUITE A, CORPUS CHRISTI, TX 78411-4734
(361) 993-1747
(361) 993-1748
Mailing address
4818 HOLLY RD, SUITE A, CORPUS CHRISTI, TX 78411-4734
(361) 993-1747
(361) 993-1748
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H8480
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00K51Q
MEDICARE
TX
05
—
109485601
—
TX
Enumeration date
09/09/2005
Last updated
03/08/2017
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