Provider Demographics
NPI:1245281492
Name:CHARBA, DEANE S (MD)
Entity type:Individual
Prefix:
First Name:DEANE
Middle Name:S
Last Name:CHARBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13409 GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3064
Mailing Address - Country:US
Mailing Address - Phone:210-492-8922
Mailing Address - Fax:210-479-2010
Practice Address - Street 1:614 FURMAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2325
Practice Address - Country:US
Practice Address - Phone:361-882-9278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114401207RN0300X
TXK6961207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00605021OtherRAILROAD MEDICARE
IL1616108OtherBCBS
WI33326800Medicaid
WI33326800Medicaid
IL211215Medicare PIN
ILP00605021OtherRAILROAD MEDICARE
IL1616108OtherBCBS
ILH18109Medicare UPIN
IL$$$$$$$$$Medicaid
ILK51186Medicare PIN