Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | E1162 | TX |
NPI | 1104888114 |
---|---|
Provider Name | Dr. Charles Nash Verheyden |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 12/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1358566-04 | (05) | TX |
1358566-07 | CSHCN (01) | TX |
240006945 | RR/MEDICARE (01) | TX |
807474 | BLUE SHIELD (01) | TX |
C22969 | (02) | TX |