MEDICARE: TEXAS CENTER FOR BREAST RECONSTRUCTION

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	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	K2452	TX
2	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	M1233	TX
3	208200000X	Plastic Surgery Physician	K2452	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992708721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS CENTER FOR BREAST RECONSTRUCTION

Provider Business Mailing Address
First Line	:	12201 MERIT DR.
Second Line	:	SUITE 440
City	:	DALLAS
State	:	TX
Zip	:	75251-2122
Country	:	US
Telephone Number	:	469-501-1466
Fax Number	:	469-501-1465

Provider Business Practice Location Address
First Line	:	12201 MERIT DR.
Second Line	:	SUITE 440
City	:	DALLAS
State	:	TX
Zip	:	75251-2122
Country	:	US
Telephone Number	:	469-501-1466
Fax Number	:	469-501-1465

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FREDERICK J. DUFFY JR.
Credential	:	M.D.
Telephone Number	:	469-501-1466

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/12/2025

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Directions to “TEXAS CENTER FOR BREAST RECONSTRUCTION ” Practice Location

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