Provider Demographics
NPI:1548503667
Name:BERENS, REBECCA DIVERS (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:DIVERS
Last Name:BERENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:DIVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 HIGHWAY 6 STE 122
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4900
Mailing Address - Country:US
Mailing Address - Phone:713-766-4496
Mailing Address - Fax:346-388-0629
Practice Address - Street 1:1111 HIGHWAY 6 STE 122
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4900
Practice Address - Country:US
Practice Address - Phone:713-766-4496
Practice Address - Fax:346-388-0629
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD457153207Q00000X
390200000X
TXR6744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program