1679559454 NPI number — DR. DAVID H MOIKEHA M.D.

Table of content: DR. DAVID H MOIKEHA M.D. (NPI 1679559454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679559454 NPI number — DR. DAVID H MOIKEHA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOIKEHA
Provider First Name:
DAVID
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOIKEHA
Provider Other First Name:
DAVID
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1679559454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 201606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75320-1606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-758-3598
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 BOOTH CALLOWAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH RICHLAND HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76180-7371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-758-3598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2005

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: 207P00000X , with the licence number:  L9369 , 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: 167397201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167397202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8K8913 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 167397203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8J1774 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00249266 . This is a "RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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