Healthcare Provider Details

I. General information

NPI: 1356443964
Provider Name (Legal Business Name): MARK DEUBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 LEMMON AVE SUITE 300
DALLAS TX
75204-2356
US

IV. Provider business mailing address

2801 LEMMON AVE SUITE 300
DALLAS TX
75204-2356
US

V. Phone/Fax

Practice location:
  • Phone: 214-220-2712
  • Fax: 214-969-0933
Mailing address:
  • Phone: 214-220-2712
  • Fax: 214-969-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberK7719
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: