Provider Demographics
NPI:1124028816
Name:VERTIL, CYPRIEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:CYPRIEN
Middle Name:L
Last Name:VERTIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1750 9TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-3600
Mailing Address - Country:US
Mailing Address - Phone:409-985-6657
Mailing Address - Fax:409-982-7805
Practice Address - Street 1:1750 9TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-3600
Practice Address - Country:US
Practice Address - Phone:409-985-6657
Practice Address - Fax:409-982-7805
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA307887208M00000X
TXJ7715207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
80X411Medicare ID - Type Unspecified
F63880Medicare UPIN