Provider Demographics
NPI:1578600813
Name:DAVID G. VANDERWEIDE, MD, PA
Entity Type:Organization
Organization Name:DAVID G. VANDERWEIDE, MD, PA
Other - Org Name:BAY AREA ORTHOPEDIC, SPINE AND SPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONG OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:STOCKAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-481-2649
Mailing Address - Street 1:12827 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4807
Mailing Address - Country:US
Mailing Address - Phone:281-481-2649
Mailing Address - Fax:281-481-0080
Practice Address - Street 1:12827 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4807
Practice Address - Country:US
Practice Address - Phone:281-481-2649
Practice Address - Fax:281-481-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5811207X00000X
TX261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396752978OtherDR. VANDERWEIDE'S NPI NO.
TXDG2569OtherRAILROAD MEDICARE GROUP #
TX8J9385OtherHOBBS MEDICARE NO.
TX1891836631OtherLESLIE HOBBS NPI
TXP00425285OtherHOBBS RAILROAD MEDICARE #
TXDG2569OtherRAILROAD MEDICARE GROUP #
TX8J9385OtherHOBBS MEDICARE NO.
TX00385WMedicare PIN