MEDICARE: DEEPTI DHALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0101X	Anatomic Pathology Physician	38020	AL
2	207ZP0101X	Anatomic Pathology Physician	V1441	TX

General Provider Information

NPI Number	:	1407968589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPTI DHALL

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	800-994-0371
Fax Number	:	254-215-9722

Provider Business Practice Location Address
First Line	:	2401 S 31ST ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76508-1900
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/29/2024

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Directions to “ DEEPTI DHALL ” Practice Location

Language	Start Address	Practice Location

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