1881739209 NPI number — VICTOR J. ATUN MD, PA

Table of content: (NPI 1881739209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881739209 NPI number — VICTOR J. ATUN MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTOR J. ATUN MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1881739209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17510 W. GRAND PARKWAY S.
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-232-6700
Provider Business Mailing Address Fax Number:
281-232-4545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17510 W. GRAND PARKWAY S.
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-232-6700
Provider Business Practice Location Address Fax Number:
281-232-4545
Provider Enumeration Date:
02/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ATUN
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
JAIME
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
281-232-6700

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  K6747 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: K6986 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: K6986 , 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: 029834101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0069HD . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".