Provider Demographics
NPI:1346253713
Name:PACL, DENNIS SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:SAMUEL
Last Name:PACL
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 1:16721 DECKER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-5012
Mailing Address - Country:US
Mailing Address - Phone:479-366-4882
Mailing Address - Fax:866-838-7772
Practice Address - Street 1:16721 DECKER CREEK DR
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-5012
Practice Address - Country:US
Practice Address - Phone:479-366-4882
Practice Address - Fax:866-838-7772
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6374207RH0002X
TXH6493207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE29321Medicare UPIN
TX1458176-01Medicaid
TX81620NMedicare PIN