Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 44938 | TN |
N | 208600000X | Surgeon | 44938 | TN |
N | 208200000X | Surgeon | MD00045223 | WA |
N | 208600000X | Surgeon | MD00045223 | WA |
N | 208200000X | Surgeon | N1940 | TX |
N | 208600000X | Surgeon | N1940 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | N1940 | TX |
NPI | 1083725972 |
---|---|
Provider Name | Jon P Verhalen |
First Address | Westlake, TX 76262-9083 |
Second Address | Colleyville, TX 76034-8002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 05/08/2020 |