Provider Demographics
NPI:1225006752
Name:HOWARD, DEMACEO (MD)
Entity Type:Individual
Prefix:
First Name:DEMACEO
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CEDAR SPRINGS RD APT 1413
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-1213
Mailing Address - Country:US
Mailing Address - Phone:309-363-0485
Mailing Address - Fax:719-598-3188
Practice Address - Street 1:7515 GREENVILLE AVE STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3849
Practice Address - Country:US
Practice Address - Phone:719-598-8155
Practice Address - Fax:719-598-3188
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2344207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036084320Medicaid
TXF28056OtherMEDICARE UPIN
TXF28056OtherMEDICARE ID-TYPE UNSPECIFIED