MEDICARE: DEANA JAMAL HUSSAMY 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	P3731	TX
2	207VM0101X	Maternal & Fetal Medicine Physician	P3731	TX

General Provider Information

NPI Number	:	1396061826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANA JAMAL HUSSAMY M.D.

Provider Business Mailing Address
First Line	:	2565 UNION CHURCH RD
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-9511
Country	:	US
Telephone Number	:	813-380-7289
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 PENNSYLVANIA AVE STE 600
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2133
Country	:	US
Telephone Number	:	817-878-5298
Fax Number	:	817-878-5289

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

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	07/21/2022

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