Provider Demographics
NPI:1396752978
Name:VANDERWEIDE, DAVID G (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:VANDERWEIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12827 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4807
Mailing Address - Country:US
Mailing Address - Phone:281-481-2649
Mailing Address - Fax:281-481-0080
Practice Address - Street 1:12827 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4807
Practice Address - Country:US
Practice Address - Phone:281-481-2649
Practice Address - Fax:281-481-0080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5811207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1578600813OtherGROUP NPI
TXP00109362OtherMEDICARE RAILROAD PROV. #
TX8K9510OtherVANDERWEIDE BCBS
TX43KZOtherGROUP BCBS
TX328385500OtherDOL
TX8K9510OtherVANDERWEIDE BCBS
TX00385WMedicare ID - Type UnspecifiedMEDICARE GROUP #
TX1578600813OtherGROUP NPI
TXP00109362OtherMEDICARE RAILROAD PROV. #
TX8J9385Medicare PIN