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Organization
JEFFREY D DECAPRIO MD PA
Active
Organization
JEFFREY D DECAPRIO MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY D DECAPRIO MD MD (OWNER)
(903) 255-0002
Entity
Organization
Contact information
Practice address
2717 SUMMERHILL RD, TEXARKANA, TX 75503-3957
(903) 794-0022
(903) 794-0023
Mailing address
PO BOX 6124, TEXARKANA, TX 75505-6124
(903) 255-0002
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
K0284
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0035MH
BC TX
TX
01
—
030800221800
QUALCHOICE
TX
05
—
15668002
—
AR
01
—
8P149
BC AR
AR
01
—
DD1753
RR MEDICARE
TX
Enumeration date
01/23/2007
Last updated
03/20/2008
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