Provider Demographics
NPI:1790998243
Name:STERN, VERA (DPM)
Entity Type:Individual
Prefix:DR
First Name:VERA
Middle Name:
Last Name:STERN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 FOREST #130D
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:972-385-0002
Mailing Address - Fax:972-385-6019
Practice Address - Street 1:5925 FOREST
Practice Address - Street 2:#130
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-385-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX957213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4410655OtherAETNA
TX018749401Medicaid
TN8A5860OtherBLUE CROSS
44292001OtherDME
00JD79Medicare ID - Type Unspecified
TX018749401Medicaid
TXT16111Medicare UPIN