Provider Demographics
NPI:1487730776
Name:VERDERY, ROY BURTON III (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:BURTON
Last Name:VERDERY
Suffix:III
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5322 N VIA ENTRADA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4827
Mailing Address - Country:US
Mailing Address - Phone:520-349-6362
Mailing Address - Fax:
Practice Address - Street 1:5322 N VIA ENTRADA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4827
Practice Address - Country:US
Practice Address - Phone:520-349-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85923207R00000X
AZ20913207R00000X
AZPB3541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G859230Medicaid
00G859230Medicare ID - Type Unspecified
CA00G859230Medicaid