Individual
MICHAELA RENEE OVERTURF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3611 NORTH ST STE 140, NACOGDOCHES, TX 75965-2478
(936) 585-7700
(936) 585-7750
Mailing address
5310 HARVEST HILL RD STE 290, DALLAS, TX 75230-5826
(214) 420-0672
(214) 736-0512
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
Q2176
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
558763
PHYSICIAN IN TRAINING PERMIT
TX
01
—
8FA656
BCBS PV #
TX
Enumeration date
05/30/2011
Last updated
07/21/2022
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