MEDICARE: DEUTERONOMY

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	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00845K	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386665495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEUTERONOMY

Provider Business Mailing Address
First Line	:	PO BOX 910042
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-0042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	874 W HIGHWAY 243
Second Line	:	SUITE 108-B
City	:	KAUFMAN
State	:	TX
Zip	:	75142-1800
Country	:	US
Telephone Number	:	972-792-5700
Fax Number	:

Authorized Official
Title or Position	:	VP ADMIN
Name	:	DEBI GLICK
Credential	:
Telephone Number	:	972-792-5700

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	06/18/2008

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Directions to “DEUTERONOMY ” Practice Location

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