Provider Demographics
NPI:1497816482
Name:VONMARENSDORFF, HANS M (MD)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:M
Last Name:VONMARENSDORFF
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1022
Mailing Address - Country:US
Mailing Address - Phone:409-747-0890
Mailing Address - Fax:409-772-0885
Practice Address - Street 1:400 HARBORSIDE DR
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0001
Practice Address - Country:US
Practice Address - Phone:409-772-2222
Practice Address - Fax:409-772-0885
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BC332OtherBCBS
TX116889002Medicaid
TX116889002Medicaid
TX00R518Medicare PIN
TX80T816Medicare ID - Type Unspecified
TXCU0323Medicare PIN
TX760010407OtherEIN
TX116889002Medicaid