Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 12977R | LA |
NPI | 1366462368 |
---|---|
Provider Name | Dr. David Theodore Vandermolen |
First Address | Shreveport, LA 71103-4010 |
Second Address | Shreveport, LA 71103-4010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1551767 | (05) | LA |
F13929 | (02) | LA |