1023018165 NPI number — DR. LEROY L STERLING

Table of content: DR. LEROY L STERLING (NPI 1023018165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023018165 NPI number — DR. LEROY L STERLING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERLING
Provider First Name:
LEROY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1023018165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77265-5113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-622-4505
Provider Business Mailing Address Fax Number:
713-877-0828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 CRAWFORD ST
Provider Second Line Business Practice Location Address:
STE 1700
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-622-4505
Provider Business Practice Location Address Fax Number:
713-877-0828
Provider Enumeration Date:
07/29/2005

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: 207RC0000X , with the licence number:  G2233 , 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: 127996003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: G2233 . This is a "TX. STATE BD. OF MED EXAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 45D0977371 . This is a "CLIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8AJ373 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com