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General NPI Number Information
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NPI Number | 1396745758
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Entity Type | Individual
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Provider Name | MICHAEL WAYNE DEEDS PAC
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 18780 INTERSTATE 20
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City | CANTON
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State | TX
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Zip | 75103-3593
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Country | US
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Telephone | 903-567-4841
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846098
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City | DALLAS
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State | TX
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Zip | 75284-6098
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Country | US
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Telephone | 903-324-6450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1500540
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10117
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA03575
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License Number State | TX
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