Individual
CAROLYN JILL VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1750 NORTH HAMPTON ROAD, DESOTO, TX 75115-2306
(214) 946-4397
(214) 946-4399
Mailing address
1750 NORTH HAMPTON ROAD, DESOTO, TX 75115-2306
(214) 946-4397
(214) 946-4399
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
K8548
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104934803
—
TX
Enumeration date
05/04/2006
Last updated
03/11/2013
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