Provider Demographics
NPI:1932657244
Name:VANDERZANT, ALEXANDER BENTON (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:BENTON
Last Name:VANDERZANT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HIGHLAND VILLAGE RD STE 600
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-8102
Mailing Address - Country:US
Mailing Address - Phone:972-317-0331
Mailing Address - Fax:972-317-3811
Practice Address - Street 1:2300 HIGHLAND VILLAGE RD STE 600
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-8102
Practice Address - Country:US
Practice Address - Phone:972-317-0331
Practice Address - Fax:972-317-3811
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant