Provider Demographics
NPI:1922336205
Name:DEBORAH T COMBS-CANTRELL MD PA
Entity Type:Organization
Organization Name:DEBORAH T COMBS-CANTRELL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILLEU
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:817-690-8873
Mailing Address - Street 1:405 STATE HIGHWAY 121 BYP
Mailing Address - Street 2:BUILDING A STE 150
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8214
Mailing Address - Country:US
Mailing Address - Phone:972-869-3448
Mailing Address - Fax:972-869-9914
Practice Address - Street 1:405 STATE HIGHWAY 121 BYP
Practice Address - Street 2:BUILDING A STE 150
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8214
Practice Address - Country:US
Practice Address - Phone:972-869-3448
Practice Address - Fax:972-869-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center