Individual
DR. ADAIR DEBERRY-CARLISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
630 S FLEISHEL AVE, TYLER, TX 75701-2041
(903) 606-5560
Mailing address
988102 NEBRASKA MEDICAL CENTER, OMAHA, NE 68198-8102
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
1974
NE
208600000X
Surgery Physician
Primary
M0050
TX
2086S0127X
Trauma Surgery Physician
007921
AZ
2086S0127X
Trauma Surgery Physician
1974
NE
2086S0127X
Trauma Surgery Physician
6836
OK
2086S0127X
Trauma Surgery Physician
71035-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197530202
—
TX
05
—
200908280A
—
OK
01
—
8AN626
BCBSTX
TX
01
—
P02531927
MEDICARE RAIL ROAD
TX
Enumeration date
07/06/2006
Last updated
06/02/2025
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