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NPI Code Detail

MEDICARE: DR. JEFFREY WAYNE CARENZA M.D.

MEDICARE:  DR. JEFFREY WAYNE CARENZA  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
12085B0100XBody Imaging PhysicianM9906TX
22085R0202XDiagnostic Radiology Physician2006013767MO
32085R0202XDiagnostic Radiology PhysicianM9906TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38AB448OTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1205937547
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY WAYNE CARENZA M.D.
Provider Business Mailing Address
First Line : 1820 PRESTON PARK BLVD
Second Line : 1825
City : PLANO
State : TX
Zip : 75093-5293
Country : US
Telephone Number : 972-867-7862
Fax Number :
Provider Business Practice Location Address
First Line : 3901 W 15TH ST
Second Line :
City : PLANO
State : TX
Zip : 75075-7738
Country : US
Telephone Number : 972-867-7962
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 08/11/2023

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Directions to “ DR. JEFFREY WAYNE CARENZA M.D.” Practice Location

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