1245233519 NPI number — DR. GREGORY C KARNAZE MD

Table of content: DR. GREGORY C KARNAZE MD (NPI 1245233519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245233519 NPI number — DR. GREGORY C KARNAZE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARNAZE
Provider First Name:
GREGORY
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245233519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12554 RIATA VISTA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78727-6431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-795-5100
Provider Business Mailing Address Fax Number:
512-795-5122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12554 RIATA VISTA CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78727-6431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-795-5100
Provider Business Practice Location Address Fax Number:
512-795-5122
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  G4320 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300127108 . This is a "RRMCARE2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 134424406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 134424404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300034071 . This is a "RRMCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 134424405 . This is a "CSHCN2" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 134424403 . This is a "CSHCN1" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com