Individual
MR. ALLEN W. VANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
604 N. ACADIA RD, SUITE 405, THIBODAUX, LA 70301
(985) 446-0871
(985) 446-0874
Mailing address
604 N. ACADIA RD., SUITE 405, THIBODAUX, LA 70301
(985) 446-0871
(985) 446-0874
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
24441
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1570796
—
LA
01
—
7394444
AETNA
—
Enumeration date
08/09/2005
Last updated
09/25/2009
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