MEDICARE: DR. TERESA JANELLE BASCOM 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	207V00000X	Obstetrics & Gynecology Physician	L0021	TX

General Provider Information

NPI Number	:	1275535049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA JANELLE BASCOM M.D.

Provider Business Mailing Address
First Line	:	1441 N. BECKLEY AVE.
Second Line	:	MEDICAL EDUCATION
City	:	DALLAS
State	:	TX
Zip	:	75203
Country	:	US
Telephone Number	:	214-947-2331
Fax Number	:	214-947-2361

Provider Business Practice Location Address
First Line	:	1441 N BECKLEY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75203-1201
Country	:	US
Telephone Number	:	214-947-8181
Fax Number	:

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	10/29/2018

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