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1043239692

NPI Code Detail

MEDICARE: DR. RALPH J DEBERARDINIS MD PHD

MEDICARE: DR. RALPH J DEBERARDINIS MD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207SG0201X	Clinical Genetics (M.D.) Physician	MD419592	PA
2	207SG0202X	Clinical Biochemical Genetics Physician	MD419592	PA
3	207SG0205X	Ph.D. Medical Genetics Physician	MD419592	PA
4	208000000X	Pediatrics Physician	MD419592	PA
5	208000000X	Pediatrics Physician	M9959	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DE08K8816	OTHER	TX	TEXAS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043239692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH J DEBERARDINIS MD PHD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	214-633-1803
Fax Number	:	214-648-5515

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:	214-633-1803
Fax Number	:	214-648-5515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/15/2013

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Directions to “ DR. RALPH J DEBERARDINIS MD PHD” Practice Location

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