Provider Demographics
NPI:1770613945
Name:JAMES H DEMBERG MD PA
Entity type:Organization
Organization Name:JAMES H DEMBERG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-596-4600
Mailing Address - Street 1:PO BOX 133170
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-3170
Mailing Address - Country:US
Mailing Address - Phone:903-596-4600
Mailing Address - Fax:
Practice Address - Street 1:1810 SHILOH RD
Practice Address - Street 2:SUITE # 501
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2419
Practice Address - Country:US
Practice Address - Phone:903-596-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF - 3096261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00114UMedicare ID - Type Unspecified