1275579336 NPI number — DR. ROGELIO GARCIA-CAVAZOS M.D.

Table of content: DR. ROGELIO GARCIA-CAVAZOS M.D. (NPI 1275579336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275579336 NPI number — DR. ROGELIO GARCIA-CAVAZOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA-CAVAZOS
Provider First Name:
ROGELIO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1275579336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4848 NE STALLINGS DR
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
NACOGDOCHES
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75965-1239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-568-3364
Provider Business Mailing Address Fax Number:
936-462-4450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4848 NE STALLINGS DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
NACOGDOCHES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75965-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-568-3364
Provider Business Practice Location Address Fax Number:
936-462-4450
Provider Enumeration Date:
06/20/2006

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: 207R00000X , with the licence number:  L7387 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X , with the licence number: L7387 , 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: 092953101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 081896501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163022004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8K5416 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00175266 . This is a "PALMETTO GBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com