1902863731 NPI number — HOMAR J BARTRA MD

Table of content: HOMAR J BARTRA MD (NPI 1902863731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902863731 NPI number — HOMAR J BARTRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTRA
Provider First Name:
HOMAR
Provider Middle Name:
J
Provider Name Prefix Text:
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:
1902863731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16811 SOUTHWEST FWY STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-4728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-276-0836
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16811 SOUTHWEST FWY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-4728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-276-0836
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2006

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:  J8905 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 33432 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: J8905 , 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: 036136205 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036136201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036136207 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036136208 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036136202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036136204 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036136206 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8W2434 . This is a "BLUE CROSS/BLUE SHIELD OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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