MEDICARE: MR. JOHN JEFFREY DEBENDER 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	F2217	TX

General Provider Information

NPI Number	:	1598708943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN JEFFREY DEBENDER M.D.

Provider Business Mailing Address
First Line	:	4151 SOUTHWEST FWY
Second Line	:	#715
City	:	HOUSTON
State	:	TX
Zip	:	77027-7312
Country	:	US
Telephone Number	:	713-622-5116
Fax Number	:	713-622-2684

Provider Business Practice Location Address
First Line	:	4151 SOUTHWEST FWY
Second Line	:	#715
City	:	HOUSTON
State	:	TX
Zip	:	77027-7312
Country	:	US
Telephone Number	:	713-622-5116
Fax Number	:	713-622-2684

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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