Provider Demographics
NPI:1245471218
Name:VONDERHAAR, DEREK JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:JOSEPH
Last Name:VONDERHAAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6959 CATINA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2303
Mailing Address - Country:US
Mailing Address - Phone:504-430-8532
Mailing Address - Fax:
Practice Address - Street 1:6959 CATINA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-2303
Practice Address - Country:US
Practice Address - Phone:504-430-8532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204086207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine