Provider Demographics
NPI:1114586534
Name:VANDOORN, PAUL KENDALL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:KENDALL
Last Name:VANDOORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MILLERSFIELD DR APT 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7765
Mailing Address - Country:US
Mailing Address - Phone:614-260-3897
Mailing Address - Fax:
Practice Address - Street 1:5500 MILLERSFIELD DR APT 104
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7765
Practice Address - Country:US
Practice Address - Phone:614-260-3897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00451175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist