# JEFFREY D DECAPRIO MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235283425
- **Authorized official:** DR. JEFFREY D DECAPRIO MD MD (OWNER)
- **Authorized official phone:** (903) 255-0002

## Contact information

- **Practice address:** 2717 SUMMERHILL RD, TEXARKANA, TX 75503-3957
- **Practice address phone:** (903) 794-0022
- **Practice address fax:** (903) 794-0023
- **Mailing address:** PO BOX 6124, TEXARKANA, TX 75505-6124
- **Mailing address phone:** (903) 255-0002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | K0284 | TX | Yes |

## Other

- **Enumeration date:** 01/23/2007
- **Last updated:** 03/20/2008

## 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 |