Provider Demographics
NPI:1508865536
Name:OVERBECK, JOHN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:OVERBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J. DOUGLAS
Other - Middle Name:
Other - Last Name:OVERBECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:701 TUSCAN DR STE 205
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3838
Mailing Address - Country:US
Mailing Address - Phone:972-253-2505
Mailing Address - Fax:833-944-1908
Practice Address - Street 1:701 TUSCAN
Practice Address - Street 2:SUITE 205
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3834
Practice Address - Country:US
Practice Address - Phone:972-253-2505
Practice Address - Fax:833-944-1908
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9376207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1354078 03Medicaid
TX1354078 03Medicaid
TX89G247Medicare PIN