1063458230 NPI number — JASBIR DHAWAN MD

Table of content: JASBIR DHAWAN MD (NPI 1063458230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063458230 NPI number — JASBIR DHAWAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DHAWAN
Provider First Name:
JASBIR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1063458230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14725 LEBANON ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-705-9000
Provider Business Mailing Address Fax Number:
214-619-5675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14725 LEBANON ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-705-9000
Provider Business Practice Location Address Fax Number:
214-619-5675
Provider Enumeration Date:
06/22/2006

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: 207R00000X , with the licence number:  2001010856 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: N0729 , 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: 100413460B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143561 . This is a "ANTHEM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2087666303 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100053530A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00116533 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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