Active NPI
Mark Dezeeuw
- Pharmacist
- Duncanville, TX
National Provider Identifier
1881908176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 24439
- Practice address
- 633 W Wheatland Rd
Duncanville, TX 75116-4517 - Phone
- (972) 780-1153
- Fax
- (972) 298-0931
- NPI assigned
- Jul 29, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 24439 | TX | Primary |
Addresses
Primary practice location
633 W Wheatland Rd
Duncanville, TX 75116-4517
Mailing address
3663 Briarpark Dr
Houston, TX 77042-5205
Phone (713) 268-3630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24439 | TX | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Randalls Food & Drugs LP | Past | Accepting new patients | |
| Randalls Food & Drugs LP | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Duncanville, TX
- NPI 1417993296
-
- Community/Retail Pharmacy
- Sanger, TX
- NPI 1730052747
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280361600000",
"number": "1881908176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3663 BRIARPARK DR",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770425205",
"telephone_number": "713-268-3630",
"fax_number": "623-869-3630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 W WHEATLAND RD",
"city": "DUNCANVILLE",
"state": "TX",
"postal_code": "751164517",
"telephone_number": "972-780-1153",
"fax_number": "972-298-0931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEZEEUW",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-29",
"last_updated": "2010-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "24439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duncanville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.