1477570810 NPI number — DR. JOHN C DE TOLEDO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477570810 NPI number — DR. JOHN C DE TOLEDO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE TOLEDO
Provider First Name:
JOHN
Provider Middle Name:
C
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:
DE TOLEDO
Provider Other First Name:
JOAO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477570810
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3601 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79430-8321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-743-2391
Provider Business Mailing Address Fax Number:
806-743-5687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79430-8321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-743-2391
Provider Business Practice Location Address Fax Number:
806-743-5687
Provider Enumeration Date:
07/15/2006

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: 2084E0001X , with the licence number:  N9361 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: N9361 , 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: 3810009737 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q0024N , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202479601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 198275 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1477570810 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 809210 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 144PN . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5907931 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3791921-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4122695 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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