Provider Demographics
NPI:1154332393
Name:HACKETT, PAUL SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SAMUEL
Last Name:HACKETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3450 W. WHEATLAND ROAD
Mailing Address - Street 2:PAVILION II SUITE 340
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4918
Mailing Address - Country:US
Mailing Address - Phone:972-709-9300
Mailing Address - Fax:972-709-9307
Practice Address - Street 1:3450 W. WHEATLAND ROAD
Practice Address - Street 2:PAVILION II SUITE 340
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-4918
Practice Address - Country:US
Practice Address - Phone:972-709-9300
Practice Address - Fax:972-709-9307
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-10-06
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Provider Licenses
StateLicense IDTaxonomies
TXN2543208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206806601Medicaid
TX206806601Medicaid