Individual
DR. JERRY ALVIN DEARTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13410 MAIN ST, BOX 340, GRABILL, IN 46741-2001
(260) 422-2481
(260) 969-3067
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01029438A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000595570
ANTHEM
IN
05
—
100055390
—
IN
01
—
P00698419
RAILROAD MEDICARE
IN
Enumeration date
08/20/2006
Last updated
10/11/2022
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