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Individual

MARK A VANDOREN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
C.R.N.A.

Contact information

Practice address
12222 MERIT DR STE 600, DALLAS, TX 75251-3294
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-2155
(972) 233-1999
(972) 233-3666

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
557932
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP109776
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002896105
TX
01
83044U
BLUE CROSS
TX
Enumeration date
10/13/2006
Last updated
06/21/2022
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