Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | MD419592 | PA |
Y | 208000000X | Pediatrician | M9959 | TX |
N | 208000000X | Pediatrician | MD419592 | PA |
NPI | 1043239692 |
---|---|
Provider Name | Dr. Ralph J Deberardinis |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 15/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
195046101 | (05) | TX |
DE08K8816 | TEXAS MEDICARE (01) | TX |