Basic Information
| Provider Information | |||||||||
| NPI: | 1245251354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEUTERONOMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 910042 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753910042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727925700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8210 WALNUT HILL LN | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752314405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727925700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | GLICK | ||||||||
| AuthorizedOfficialFirstName: | DEBI | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 9727925700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1198368-02 | 05 | TX | MEDICAID | 0018BV | 01 | TX | BCBS | OTHER |