Healthcare Provider Details

I. General information

NPI: 1205432861
Provider Name (Legal Business Name): OCCMEDTX, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 N 10TH ST
ABILENE TX
79603-4640
US

IV. Provider business mailing address

2074 ANTILLEY RD
ABILENE TX
79606-5209
US

V. Phone/Fax

Practice location:
  • Phone: 325-437-8620
  • Fax:
Mailing address:
  • Phone: 325-698-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CLIFFORD L DEPRANG
Title or Position: OWNER
Credential: MD
Phone: 325-698-3865