Individual
DR. JEFFREY DAVID DECAPRIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
(903) 614-3525
Mailing address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
(903) 614-3525
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
K0284
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0035MH
BLUE CROSS/BLUE SHIELD
TX
01
—
03080021800
QUALCHOICE QCA OF AR
TX
05
—
149598001
—
AR
05
—
157600102
—
TX
05
—
157600103
—
TX
01
—
82411
GROUP 8-P149
AR
Enumeration date
06/17/2005
Last updated
09/07/2023
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