Individual
DR. DOMINIC R. DEKERATRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 SCENIC DRIVE, SUITE 2208, GEORGETOWN, TX 78626
(512) 819-0132
(512) 819-9335
Mailing address
PO BOX 678698, DALLAS, TX 75267-8698
(512) 637-2002
(512) 637-2007
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
L0787
TX
207RP1001X
Pulmonary Disease Physician
Primary
L0787
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1436107-03
—
TX
Enumeration date
03/22/2006
Last updated
08/08/2018
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