Individual
DAVID LOYD VANDERHEIDEN I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4818 HOLLY RD, SUITE A, CORPUS CHRISTI, TX 78411-4734
(361) 993-1747
(361) 993-1748
Mailing address
4818 HOLLY RD, SUITE A, CORPUS CHRISTI, TX 78411-4734
(361) 993-1747
(361) 993-1748
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H8480
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114951003
—
TX
01
—
88T881
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/09/2005
Last updated
03/08/2017
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