Organization
THOMAS DEPORTER, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS ELDEN DEPORTER MD (OWNER)
(682) 224-1703
Entity
Organization
Contact information
Practice address
6410 SOUTHWEST BLVD STE 100, BENBROOK, TX 76109-3918
(682) 224-1703
Mailing address
6410 SOUTHWEST BLVD STE 100, BENBROOK, TX 76109-3918
(682) 224-1703
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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