Provider Demographics
NPI:1295870459
Name:SOUTHWESTERN DIABETIC PHYSICIANS ASSOCIATION
Entity type:Organization
Organization Name:SOUTHWESTERN DIABETIC PHYSICIANS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:VANDERMEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-665-2011
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76241-0918
Mailing Address - Country:US
Mailing Address - Phone:940-665-2011
Mailing Address - Fax:940-665-9467
Practice Address - Street 1:10687 FM 678
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:TX
Practice Address - Zip Code:76273-4840
Practice Address - Country:US
Practice Address - Phone:940-665-2011
Practice Address - Fax:940-665-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG80802080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty