Provider Demographics
NPI:1043239692
Name:DEBERARDINIS, RALPH J (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:J
Last Name:DEBERARDINIS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-633-1803
Mailing Address - Fax:214-648-5515
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-633-1803
Practice Address - Fax:214-648-5515
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419592207SG0201X, 207SG0202X, 207SG0205X, 208000000X
TXM9959208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
No207SG0205XAllopathic & Osteopathic PhysiciansMedical GeneticsPh.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195046101Medicaid
TXDE08K8816OtherTEXAS MEDICARE