Gary G. Deckelboim, M.D. P.a.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

J0940 Issued in TX

Legal business name

GARY G. DECKELBOIM, M.D. P.A.

Practice address

8210 Walnut Hill Lane
Suite 100 LB-5
Dallas, TX 75231-4418

Phone

(214) 369-8478

Fax

(214) 696-1594

NPI assigned

Sep 28, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary G Deckelboim, M.D.

Title

Physician

Phone

(214) 369-8478

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317168000000",
    "number": "1356624183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8210 WALNUT HILL LANE",
            "address_2": "SUITE 100 LB-5",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314418",
            "telephone_number": "214-369-8478",
            "fax_number": "214-696-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8210 WALNUT HILL LANE",
            "address_2": "SUITE 100 LB-5",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314418",
            "telephone_number": "214-369-8478",
            "fax_number": "214-696-1594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY G. DECKELBOIM, M.D. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-28",
        "last_updated": "2011-09-28",
        "status": "A",
        "authorized_official_last_name": "DECKELBOIM",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "214-369-8478",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "J0940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Ophthalmology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.