Healthcare Provider Details

I. General information

NPI: 1124028816
Provider Name (Legal Business Name): CYPRIEN L VERTIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HIGHWAY 365 STE 210
NEDERLAND TX
77627-6283
US

IV. Provider business mailing address

2300 HIGHWAY 365 STE 210
NEDERLAND TX
77627-6283
US

V. Phone/Fax

Practice location:
  • Phone: 409-985-6657
  • Fax: 409-982-7805
Mailing address:
  • Phone: 409-985-6657
  • Fax: 409-982-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number307887
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberJ7715
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: