Provider Demographics
NPI:1396821997
Name:VANDERBURG, JAMES RALPH III (M D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RALPH
Last Name:VANDERBURG
Suffix:III
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2701 US HIGHWAY 271 N STE 301
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-4289
Mailing Address - Country:US
Mailing Address - Phone:903-465-4429
Mailing Address - Fax:903-946-5258
Practice Address - Street 1:2701 US HIGHWAY 271 N
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-4289
Practice Address - Country:US
Practice Address - Phone:903-946-5442
Practice Address - Fax:903-946-5258
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9689207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160057488OtherRAILROAD MEDICARE
TX8F5690OtherBLUE CROSS/BLUE SHIELD
TX096818202Medicaid
TX096818202Medicaid
TX8F5690OtherBLUE CROSS/BLUE SHIELD