Healthcare Provider Details

I. General information

NPI: 1447249966
Provider Name (Legal Business Name): CHRISTINE D DESOCARRAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 COIT RD SUITE 900
PLANO TX
75075-5721
US

IV. Provider business mailing address

304 COIT RD SUITE 900
PLANO TX
75075-5721
US

V. Phone/Fax

Practice location:
  • Phone: 972-312-1806
  • Fax: 972-312-9401
Mailing address:
  • Phone: 972-312-1806
  • Fax: 972-312-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberF7736
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberF7736
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: