Provider Demographics
NPI:1205432861
Name:OCCMEDTX, PLLC
Entity type:Organization
Organization Name:OCCMEDTX, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEPRANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-698-3865
Mailing Address - Street 1:2074 ANTILLEY RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5209
Mailing Address - Country:US
Mailing Address - Phone:325-698-3865
Mailing Address - Fax:
Practice Address - Street 1:3449 N 10TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-4640
Practice Address - Country:US
Practice Address - Phone:325-437-8620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty