1760653364 NPI number — MR. PHILIP T HOUSER II MD

Table of content: MR. PHILIP T HOUSER II MD (NPI 1760653364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760653364 NPI number — MR. PHILIP T HOUSER II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSER
Provider First Name:
PHILIP
Provider Middle Name:
T
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
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:
1760653364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 NE LOOP 410
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78216-5832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-375-7790
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 NE LOOP 410
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216-5832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-375-7790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2008

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: 207L00000X , with the licence number:  P2460 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200436200A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8DH307 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 301621401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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