1639394562 NPI number — TAMRA K. DEUSER, M.D., P.A.

Table of content: (NPI 1639394562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639394562 NPI number — TAMRA K. DEUSER, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMRA K. DEUSER, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639394562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 FLOWER MOUND ROAD
Provider Second Line Business Mailing Address:
SUITE 133
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028-4202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-899-8200
Provider Business Mailing Address Fax Number:
972-899-8202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 FLOWER MOUND RD
Provider Second Line Business Practice Location Address:
133
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-899-8200
Provider Business Practice Location Address Fax Number:
972-899-8202
Provider Enumeration Date:
04/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEUSER
Authorized Official First Name:
TAMRA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-899-8200

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  L3951 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: L3951 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1770578650 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".