MEDICARE: DR. JUNIOR DEFREITAS M.D.

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	174400000X	Specialist	J9655	TX
2	207Y00000X	Otolaryngology Physician	J9655	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548254188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNIOR DEFREITAS M.D.

Provider Business Mailing Address
First Line	:	3324 COLORADO BLVD
Second Line	:	STE 103
City	:	DENTON
State	:	TX
Zip	:	76210
Country	:	US
Telephone Number	:	940-891-1788
Fax Number	:	940-891-1658

Provider Business Practice Location Address
First Line	:	3324 COLORADO BLVD
Second Line	:	STE 103
City	:	DENTON
State	:	TX
Zip	:	76210
Country	:	US
Telephone Number	:	940-891-1788
Fax Number	:	940-891-1658

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	11/16/2009

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