Provider Demographics
NPI:1578501664
Name:TEBCHERANY, DINA JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:JOSEPH
Last Name:TEBCHERANY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:4101 JAMES CASEY ST
Practice Address - Street 2:100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3325
Practice Address - Country:US
Practice Address - Phone:512-447-2202
Practice Address - Fax:512-447-3802
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3159207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152742603Medicaid
TX152742604Medicaid
TX152742605Medicaid
TX8R1564OtherBLUE CROSS OF TEXAS
TX830008332Medicare PIN
TX8L8914Medicare PIN
TX8D5777Medicare PIN
TX152742603Medicaid