1326212895 NPI number — JEFFERY S CANTRELL MD PA

Table of content: (NPI 1326212895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326212895 NPI number — JEFFERY S CANTRELL MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERY S CANTRELL MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1326212895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 977
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75067-0977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-420-1776
Provider Business Mailing Address Fax Number:
972-221-8685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2960 LONG PRAIRIE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75022-4845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-420-1776
Provider Business Practice Location Address Fax Number:
972-221-8685
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CANTRELL
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
972-420-1776

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  H6092 , 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: 0070QP . This is a "BLUESHIELD PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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