Healthcare Provider Details

I. General information

NPI: 1245281492
Provider Name (Legal Business Name): DEANE S CHARBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 FURMAN AVE
CORPUS CHRISTI TX
78404-2325
US

IV. Provider business mailing address

13409 GEORGE RD
SAN ANTONIO TX
78230-3064
US

V. Phone/Fax

Practice location:
  • Phone: 361-882-9278
  • Fax:
Mailing address:
  • Phone: 210-492-8922
  • Fax: 210-479-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036114401
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberK6961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: