Provider Demographics
NPI:1194800367
Name:VERT, DEBORAH S (DO)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:VERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:225 SE JOHN JONES DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8341
Practice Address - Country:US
Practice Address - Phone:817-447-0445
Practice Address - Fax:817-447-2273
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK0392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP IHN
TX1150946OtherFIRSTHEALTH PIN
TX1804714OtherUHC PIN
TX140442872Medicaid
TX87123GOtherBCBSTX IND PIN
TX121344909Medicaid
TX121344906Medicaid
TX5214612OtherAETNA PIN
TX121344905Medicaid
TX0871950OtherCIGNA PIN
1750369203OtherGRP NPI NUMBER
TX137072810Medicaid
TXVERDG67395OtherCCHIP PIN
TX121344910OtherCSHCN
TX137072804Medicaid
TX140442872Medicaid
TX1150946OtherFIRSTHEALTH PIN
TX137072804Medicaid
TX5214612OtherAETNA PIN