Provider Demographics
NPI:1184718843
Name:VORDERMARK, JONATHAN S (MD)
Entity type:Individual
Prefix:MISS
First Name:JONATHAN
Middle Name:S
Last Name:VORDERMARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:SUITE 260
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-743-1810
Practice Address - Fax:806-743-1335
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF61562088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89C198OtherBC/BS
NMU5622Medicaid
TX87990ZOtherHMO BLUE
TXE46803Medicare UPIN
NMU5622Medicaid