Individual
DR. SUSAN DEAN VAN DE WATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1030 N GRANDVIEW AVE, ODESSA, TX 79761-3149
(432) 570-0373
(432) 687-3143
Mailing address
PO BOX 62227, MIDLAND, TX 79711-2227
(432) 570-0373
(432) 687-3143
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
H2869
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0895096-01
—
TX
01
—
180317300
DEPT OF LABOR
—
Enumeration date
02/06/2006
Last updated
05/28/2013
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