=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407059561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEETHA MALINI DEVDAS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2007
-----------------------------------------------------
Last Update Date | 04/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 7TH AVE
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-2733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-885-3199
-----------------------------------------------------
Fax | 682-885-7499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 733784
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75373-3784
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-885-1855
-----------------------------------------------------
Fax | 682-885-1396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PP0204X
-----------------------------------------------------
Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
-----------------------------------------------------
License Number | M7139
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------