MEDICARE: DR. JOHN DEBEVITS IV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	T2350	TX
2	2085R0202X	Diagnostic Radiology Physician	13680664-1205	UT
3	2085R0202X	Diagnostic Radiology Physician	036179000	IL

General Provider Information

NPI Number	:	1003203324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DEBEVITS IV M.D.

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:	214-648-3928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	03/03/2026

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