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General NPI Number Information
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NPI Number | 1083725972
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Entity Type | Individual
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Provider Name | JON P VERHALEN MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 7167 COLLEYVILLE BLVD STE 102
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City | COLLEYVILLE
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State | TX
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Zip | 76034-8002
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Country | US
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Telephone | 817-484-0169
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Fax | 817-809-7820
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Provider Business Mailing Address
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Address Line | 1717 WISTERIA WAY
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City | WESTLAKE
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State | TX
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Zip | 76262-9083
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Country | US
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Telephone | 206-963-8714
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | N1940
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 44938
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MD00045223
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | N1940
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License Number State | TX
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