Provider Demographics
NPI:1902082175
Name:PAUL VAN DEVENTER, M.D., APMC
Entity Type:Organization
Organization Name:PAUL VAN DEVENTER, M.D., APMC
Other - Org Name:ORTHOPAEDIC CLINIC OF MANDEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MATTHEWS
Authorized Official - Last Name:VAN DEVENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-674-1700
Mailing Address - Street 1:2330 N CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6402
Mailing Address - Country:US
Mailing Address - Phone:985-674-1700
Mailing Address - Fax:985-674-1722
Practice Address - Street 1:2330 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6402
Practice Address - Country:US
Practice Address - Phone:985-674-1700
Practice Address - Fax:985-674-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty