Provider Demographics
NPI:1477681385
Name:CENTER FOR FERTILITY
Entity Type:Organization
Organization Name:CENTER FOR FERTILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERMOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-212-8270
Mailing Address - Street 1:2401 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4010
Mailing Address - Country:US
Mailing Address - Phone:318-212-8270
Mailing Address - Fax:318-212-8230
Practice Address - Street 1:2401 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4010
Practice Address - Country:US
Practice Address - Phone:318-212-8270
Practice Address - Fax:318-212-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty