Provider Demographics
NPI:1417952060
Name:VAN DELL, HARVEY G IV (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:G
Last Name:VAN DELL
Suffix:IV
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 1:2980 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4845
Mailing Address - Country:US
Mailing Address - Phone:972-899-9787
Mailing Address - Fax:972-899-9786
Practice Address - Street 1:2980 LONG PRAIRIE RD
Practice Address - Street 2:SUITE E
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4845
Practice Address - Country:US
Practice Address - Phone:972-899-9787
Practice Address - Fax:972-899-9786
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8697207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151184703Medicaid
TX10007551OtherAMERIGROUP
TX8AJ973OtherBLUE CROSS AND BLUE SHIELD
TX5397424OtherCIGNA
TX7215354OtherAETNA
TX151184703Medicaid
TX7215354OtherAETNA