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General NPI Number Information
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NPI Number | 1780927152
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Entity Type | Organization
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Legal Business Name | NORTH CENTRAL TEXAS UROLOGY, PLLC
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 805 HILL BLVD STE 106-107
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City | GRANDBURY
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State | TX
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Zip | 76048-1481
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Country | US
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Telephone | 817-599-3690
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Fax | 817-599-6633
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Provider Business Mailing Address
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Address Line | 805 HILL BLVD STE 106-107
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City | GRANDBURY
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State | TX
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Zip | 76048-1481
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Country | US
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Telephone | 817-599-3690
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Fax | 817-599-6633
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Authorized Official
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Title or Position | OWNER/ MANAGER
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Name | AVI T DESHMUKH
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Credential | MD
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Telephone | 817-599-3690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | H1067
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License Number State | TX
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