Provider Demographics
NPI:1851303226
Name:VERNON & WALDREP OB-GYN ASSOCIATES
Entity Type:Organization
Organization Name:VERNON & WALDREP OB-GYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:DAWSON
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-4660
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:BLDG D-570
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-4660
Mailing Address - Fax:972-566-6413
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:BLDG D-570
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-4660
Practice Address - Fax:972-566-6413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX809549-03207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085504101Medicaid
TXTS84Medicare ID - Type Unspecified