Individual
KEVIN MARINUS VANDEN BERGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
351 E TARLETON ST, STEPHENVILLE, TX 76401-3511
(254) 968-0292
(888) 289-1607
Mailing address
PO BOX 2576, STEPHENVILLE, TX 76401-0043
(254) 968-0292
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
N2329
TX
390200000X
Student in an Organized Health Care Education/Training Program
AP 2247799-54061
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281982301
—
TX
01
—
8CU164
BLUE CROSS
—
Enumeration date
05/08/2007
Last updated
03/29/2019
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