Provider Demographics
NPI:1083725972
Name:VERHALEN, JON P (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:P
Last Name:VERHALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1717 WISTERIA WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-9083
Mailing Address - Country:US
Mailing Address - Phone:206-963-8714
Mailing Address - Fax:
Practice Address - Street 1:7167 COLLEYVILLE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8002
Practice Address - Country:US
Practice Address - Phone:817-484-0169
Practice Address - Fax:817-809-7820
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN1940208200000X, 2086S0122X
TN44938208200000X
WAMD00045223208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery