Healthcare Provider Details

I. General information

NPI: 1619469343
Provider Name (Legal Business Name): DEULOFEUT PHYSICIAN SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 PINE ST STE 401B
ABILENE TX
79601-2452
US

IV. Provider business mailing address

PO BOX 5379
ABILENE TX
79608-5379
US

V. Phone/Fax

Practice location:
  • Phone: 325-676-0557
  • Fax: 866-673-1339
Mailing address:
  • Phone: 325-676-0557
  • Fax: 866-673-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberM3518
License Number StateTX

VIII. Authorized Official

Name: RICHARD DEULOFEUT
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 325-676-0557