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General NPI Number Information
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NPI Number | 1356624183
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Entity Type | Organization
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Legal Business Name | GARY G. DECKELBOIM, M.D. P.A.
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 8210 WALNUT HILL LANE SUITE 100 LB-5
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City | DALLAS
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State | TX
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Zip | 75231-4418
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Country | US
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Telephone | 214-369-8478
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Fax | 214-696-1594
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Provider Business Mailing Address
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Address Line | 8210 WALNUT HILL LANE SUITE 100 LB-5
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City | DALLAS
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State | TX
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Zip | 75231-4418
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Country | US
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Telephone | 214-369-8478
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Fax | 214-696-1594
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GARY G DECKELBOIM
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Credential | M.D.
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Telephone | 214-369-8478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | J0940
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License Number State | TX
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