Provider Demographics
NPI:1447249966
Name:DESOCARRAZ, CHRISTINE D (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:D
Last Name:DESOCARRAZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:304 COIT RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5721
Mailing Address - Country:US
Mailing Address - Phone:972-312-1806
Mailing Address - Fax:972-312-9401
Practice Address - Street 1:304 COIT RD
Practice Address - Street 2:SUITE 900
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5721
Practice Address - Country:US
Practice Address - Phone:972-312-1806
Practice Address - Fax:972-312-9401
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2016-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF7736208D00000X
UTF77362083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613563OtherMEDICARE PTAN
TX132080603Medicaid
TX89041GOtherBCBS OF TEXAS
TXOOTG92OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX132080603Medicaid