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Organization
DEUTERONOMY
Active
Organization
DEUTERONOMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBI GLICK (VP ADMIN)
(972) 792-5700
Entity
Organization
Contact information
Practice address
1604 HOSPITAL PKWY, SUITE 100, BEDFORD, TX 76022-6986
(972) 792-5700
Mailing address
PO BOX 910042, DALLAS, TX 75391-0042
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00846K
BCBS
TX
Enumeration date
07/22/2006
Last updated
12/10/2007
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