1265657506 NPI number — DR. SIMON STUDENY MD

Table of content: DR. SIMON STUDENY MD (NPI 1265657506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265657506 NPI number — DR. SIMON STUDENY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUDENY
Provider First Name:
SIMON
Provider Middle Name:
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:
1265657506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 E JOHN CARPENTER FWY
Provider Second Line Business Mailing Address:
SUITE 850
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75062-2727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-957-3000
Provider Business Mailing Address Fax Number:
972-957-3005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3247 DAWES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75211-5760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-330-7767
Provider Business Practice Location Address Fax Number:
214-330-7780
Provider Enumeration Date:
04/13/2007

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: 207P00000X , with the licence number:  N4137 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: RL10048 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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