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1447255229

NPI Code Detail

MEDICARE: DR. JEFFREY DAVID DECAPRIO MD

MEDICARE: DR. JEFFREY DAVID DECAPRIO MD

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	2086S0129X	Vascular Surgery Physician	K0284	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03080021800	OTHER	TX	QUALCHOICE QCA OF AR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0035MH	OTHER	TX	BLUE CROSS/BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	82411	OTHER	AR	GROUP 8-P149

General Provider Information

NPI Number	:	1447255229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY DAVID DECAPRIO MD

Provider Business Mailing Address
First Line	:	5002 COWHORN CREEK RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-9766
Country	:	US
Telephone Number	:	903-614-3000
Fax Number	:	903-614-3525

Provider Business Practice Location Address
First Line	:	5002 COWHORN CREEK RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-9766
Country	:	US
Telephone Number	:	903-614-3000
Fax Number	:	903-614-3525

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	09/07/2023

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Directions to “ DR. JEFFREY DAVID DECAPRIO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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