1528365830 NPI number — MR. WAYNE CHRISTOPHER BELAIRE WAYNE BELAIRE

Table of content: MR. WAYNE CHRISTOPHER BELAIRE WAYNE BELAIRE (NPI 1528365830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528365830 NPI number — MR. WAYNE CHRISTOPHER BELAIRE WAYNE BELAIRE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELAIRE
Provider First Name:
WAYNE
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
WAYNE BELAIRE
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELAIRE
Provider Other First Name:
WAYNE
Provider Other Middle Name:
CHRISTOPHER
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
WAYNE BELAIRE
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1528365830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3167 MARIANNWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT NECHES
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77651-6015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-626-1866
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3167 MARIANNWOOD DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT NECHES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77651-6015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-626-1866
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2011

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: 163WR0006X , with the licence number:  605997 , 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)





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