Healthcare Provider Details

I. General information

NPI: 1821225772
Provider Name (Legal Business Name): DENTON PROFESSIONAL MEDICAL GROUP,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 COLORADO BLVD
DENTON TX
76210-6863
US

IV. Provider business mailing address

3201 COLORADO BLVD
DENTON TX
76210-6863
US

V. Phone/Fax

Practice location:
  • Phone: 940-381-0885
  • Fax: 940-380-0382
Mailing address:
  • Phone: 940-381-0885
  • Fax: 940-380-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOS5264
License Number StateFL

VIII. Authorized Official

Name: MICHAEL FLICKER
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 940-381-0885