Provider Demographics
NPI:1326241324
Name:MANDERS, DUSTIN B (MD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:B
Last Name:MANDERS
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:8196 WALNUT HILL LN STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7001
Practice Address - Country:US
Practice Address - Phone:214-739-4175
Practice Address - Fax:214-345-7684
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8157207V00000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213145004Medicaid
TXP01752676OtherRAILROAD
BP1-0026457OtherINSTITUTIONAL PERMIT
TX213145003Medicaid
TXP01752676OtherRAILROAD
TX213145004Medicaid