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Individual

ANDREW L DEJONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1730 BIRMINGHAM DR, COLLEGE STATION, TX 77845-4063
(979) 693-6000
(979) 693-1900
Mailing address
PO BOX 10194, COLLEGE STATION, TX 77842-0194
(979) 693-6000
(979) 693-1900

Taxonomy

Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
J1079
TX
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
J1079
TX
207YX0602X
Otolaryngic Allergy Physician
J1079
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
135825109
TX
01
80102845
DPS
TX
Enumeration date
06/02/2006
Last updated
03/07/2023
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