Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | K1807 | TX |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | K1807 | TX |
NPI | 1124020185 |
---|---|
Provider Name | Marc M. Dehart |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 17/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0389819-02 | (05) | TX |
0389819-03 | (05) | TX |
038981904 | (05) | TX |
038981905 | CSHCN (01) | TX |
8K0250 | BC/BS (01) | TX |
F81472 | (02) | TX |