=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386737120
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES DEMBERG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 03/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7121 S.P.I.D. SUITE 300
-----------------------------------------------------
City | COPUS CHRISTI
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78412-4389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-696-6200
-----------------------------------------------------
Fax | 361-696-6054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 6409
-----------------------------------------------------
City | CORPUS CHRISTI
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78466-6409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-696-6200
-----------------------------------------------------
Fax | 361-696-6054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | F3096
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------