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NPI Code Detail

MEDICARE: JEFFREY D DECAPRIO MD PA

MEDICARE: JEFFREY D DECAPRIO MD PA
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
12086S0129XVascular Surgery PhysicianK0284TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5DD1753OTHERTXRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18P149OTHERARBC AR
20035MHOTHERTXBC TX
3030800221800OTHERTXQUALCHOICE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235283425
Entity Type Code : Organization
Provider Name (Legal Business Name) : JEFFREY D DECAPRIO MD PA
Provider Business Mailing Address
First Line : PO BOX 6124
Second Line :
City : TEXARKANA
State : TX
Zip : 75505-6124
Country : US
Telephone Number : 903-255-0002
Fax Number :
Provider Business Practice Location Address
First Line : 2717 SUMMERHILL RD
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-3957
Country : US
Telephone Number : 903-794-0022
Fax Number : 903-794-0023
Authorized Official
Title or Position : OWNER
Name : DR. JEFFREY D DECAPRIO MD
Credential : MD
Telephone Number : 903-255-0002
Provider Enumeration Date : 01/23/2007
Last Update Date : 03/20/2008

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Directions to “JEFFREY D DECAPRIO MD PA ” Practice Location

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