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NPI Code Detail

MEDICARE: ERROL DEROUEN

MEDICARE: ERROL DEROUEN
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
11223S0112XOral and Maxillofacial Surgery (Dentist)7878TX

General Provider Information

NPI Number : 1477609972
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERROL DEROUEN
Provider Business Mailing Address
First Line : 650 INTERNATIONAL PKWY
Second Line : SUITE 550
City : RICHARDSON
State : TX
Zip : 75081-6612
Country : US
Telephone Number : 817-540-2223
Fax Number :
Provider Business Practice Location Address
First Line : 1717 AIRPORT FWY
Second Line :
City : BEDFORD
State : TX
Zip : 76021-5731
Country : US
Telephone Number : 817-540-2223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 07/08/2007

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Directions to “ ERROL DEROUEN ” Practice Location

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