Provider Demographics
NPI:1912979790
Name:DECKELBOIM, GARY G (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:G
Last Name:DECKELBOIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8210 WALNUT HILL LN
Mailing Address - Street 2:SUITE 100 LB-5
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4405
Mailing Address - Country:US
Mailing Address - Phone:214-369-8478
Mailing Address - Fax:214-696-1594
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:SUITE 100 LB-5
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4405
Practice Address - Country:US
Practice Address - Phone:214-369-8478
Practice Address - Fax:214-696-1594
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0940207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology