Provider Demographics
NPI:1225002850
Name:EVERETT, HAROLD U (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:U
Last Name:EVERETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:706 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1833
Practice Address - Country:US
Practice Address - Phone:903-595-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6424208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370009031OtherMEDICARE RAILROAD
TXEV082Z310OtherBCBS
TX135158705Medicaid
TX135158710Medicaid
TX135158711Medicaid
TX5598227OtherAETNA
TXTIN PLUS SUFFIX 027OtherTRICARE
TX123073OtherCHIPS
TX135158712Medicaid
TX018024201OtherEPSDT
TX370009031OtherMEDICARE RAILROAD
G13430Medicare UPIN
TX123073OtherCHIPS
TX135158705Medicaid