Provider Demographics
NPI:1871998880
Name:VANDYKE, LINDSEY (DO)
Entity type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:STANNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 MATLOCK RD STE 304
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4435
Mailing Address - Country:US
Mailing Address - Phone:817-380-4880
Mailing Address - Fax:817-788-8416
Practice Address - Street 1:1900 MATLOCK RD STE 304
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4435
Practice Address - Country:US
Practice Address - Phone:817-380-4880
Practice Address - Fax:817-788-8416
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13668207R00000X
TXR7919207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A13668OtherCA OSTEOPATHIC PHYSICIAN AND SURGEON