MEDICARE: JANICE VERBOSKY MD, IBCLC

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	208000000X	Pediatrics Physician	85676	GA

General Provider Information

NPI Number	:	1386040996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE VERBOSKY MD, IBCLC

Provider Business Mailing Address
First Line	:	5801 W WADLEY AVE
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5055
Country	:	US
Telephone Number	:	432-699-2636
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 W WADLEY AVE
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5055
Country	:	US
Telephone Number	:	432-699-2636
Fax Number	:

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

Provider Enumeration Date	:	11/08/2014
Last Update Date	:	12/14/2022

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