Provider Demographics
NPI:1386040996
Name:VERBOSKY, JANICE (MD, IBCLC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:VERBOSKY
Suffix:
Gender:F
Credentials:MD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 W WADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5055
Mailing Address - Country:US
Mailing Address - Phone:432-699-2636
Mailing Address - Fax:
Practice Address - Street 1:5801 W WADLEY AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5055
Practice Address - Country:US
Practice Address - Phone:432-699-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-08
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85676208000000X
TXTEMP208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics