Individual
DAVID CARLO DE FAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6606 LBJ FWY, SUITE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036-121146
IL
207L00000X
Anesthesiology Physician
Primary
N6853
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215771103
—
TX
01
—
8EX399
BCBS
TX
Enumeration date
08/01/2008
Last updated
04/30/2020
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