1689846701 NPI number — DR. JOHN O LUSINS III M.D.

Table of content: DR. JOHN O LUSINS III M.D. (NPI 1689846701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689846701 NPI number — DR. JOHN O LUSINS III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUSINS
Provider First Name:
JOHN
Provider Middle Name:
O
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
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:
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:
1689846701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6625 WOOLDRIDGE RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78414-2916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-356-6441
Provider Business Mailing Address Fax Number:
361-356-6565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6625 WOOLDRIDGE RD
Provider Second Line Business Practice Location Address:
101
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78414-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-356-6441
Provider Business Practice Location Address Fax Number:
361-356-6565
Provider Enumeration Date:
03/28/2008

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: 2084F0202X , with the licence number:  P6863 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: P6863 , 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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