Provider Demographics
NPI:1033123112
Name:MCCALL, DEANNA R (PA)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:R
Last Name:MCCALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4131 S BUCKNER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-4318
Mailing Address - Country:US
Mailing Address - Phone:214-388-0202
Mailing Address - Fax:214-388-0214
Practice Address - Street 1:4131 S BUCKNER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-4318
Practice Address - Country:US
Practice Address - Phone:214-388-0202
Practice Address - Fax:214-388-0214
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04697363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA04697OtherPHYSICIAN ASSISTANTS