Provider Demographics
NPI:1386623759
Name:DAUERTY, BARBARA DOROTHEA (PA)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:DOROTHEA
Last Name:DAUERTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 STATE HIGHWAY 173 N UNIT 519
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-8025
Mailing Address - Country:US
Mailing Address - Phone:830-792-3251
Mailing Address - Fax:830-796-3840
Practice Address - Street 1:1116 12TH STREET SUITE # 3
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003
Practice Address - Country:US
Practice Address - Phone:830-796-3448
Practice Address - Fax:830-796-3840
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000942363AM0700X
WAPA10003237363AM0700X
TXPA13239363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1801292800OtherGROUP NPI #
TXPA13239OtherTEXAS MEDICAL BOARD