Provider Demographics
NPI:1598708943
Name:DEBENDER, JOHN JEFFREY (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JEFFREY
Last Name:DEBENDER
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 1:4151 SOUTHWEST FWY
Mailing Address - Street 2:#715
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7312
Mailing Address - Country:US
Mailing Address - Phone:713-622-5116
Mailing Address - Fax:713-622-2684
Practice Address - Street 1:4151 SOUTHWEST FWY
Practice Address - Street 2:#715
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7312
Practice Address - Country:US
Practice Address - Phone:713-622-5116
Practice Address - Fax:713-622-2684
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2217174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22184Medicare UPIN
TXOOER39Medicare ID - Type Unspecified