Provider Demographics
NPI:1962499947
Name:VENTURA, GERARD J (MD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:J
Last Name:VENTURA
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 1:409 RUSSELL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1248
Mailing Address - Country:US
Mailing Address - Phone:936-569-0050
Mailing Address - Fax:936-569-1483
Practice Address - Street 1:409 RUSSELL BLVD STE B
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965
Practice Address - Country:US
Practice Address - Phone:936-569-0050
Practice Address - Fax:936-569-1483
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9680207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
752307652OtherCOMMERCIAL INSURANCE
TX0978744-02Medicaid
TX830007888OtherRAILROAD MEDICARE
TX00D56JMedicare ID - Type Unspecified
TX0978744-02Medicaid