Provider Demographics
NPI:1144514803
Name:OVERTURF, MICHAELA RENEE (MD)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:RENEE
Last Name:OVERTURF
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5310 HARVEST HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5826
Mailing Address - Country:US
Mailing Address - Phone:214-420-0672
Mailing Address - Fax:214-736-0512
Practice Address - Street 1:3611 NORTH ST STE 140
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2478
Practice Address - Country:US
Practice Address - Phone:936-585-7700
Practice Address - Fax:936-585-7750
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ2176207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX558763OtherPHYSICIAN IN TRAINING PERMIT
TX8FA656OtherBCBS PV #