Provider Demographics
NPI:1144219312
Name:VESELKA, DEANNE L (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANNE
Middle Name:L
Last Name:VESELKA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2800 S TEXAS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5361
Mailing Address - Country:US
Mailing Address - Phone:936-266-3513
Mailing Address - Fax:936-266-8618
Practice Address - Street 1:4421 STATE HIGHWAY 6 S STE 100
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6176
Practice Address - Country:US
Practice Address - Phone:979-690-4460
Practice Address - Fax:979-690-4461
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2023-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL5168207Q00000X
CO41351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144219312Medicaid
CO55607225Medicaid
COH82378Medicare UPIN