1104876879 NPI number — DR. HENRY P LOBSTEIN M.D.

Table of content: DR. HENRY P LOBSTEIN M.D. (NPI 1104876879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104876879 NPI number — DR. HENRY P LOBSTEIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOBSTEIN
Provider First Name:
HENRY
Provider Middle Name:
P
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:
LOBSTEIN
Provider Other First Name:
HENRY
Provider Other Middle Name:
PHILEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104876879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1017 12TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-3915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-334-2800
Provider Business Mailing Address Fax Number:
817-336-1954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1017 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-3915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-334-2800
Provider Business Practice Location Address Fax Number:
817-336-1954
Provider Enumeration Date:
05/11/2006

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: 207RC0000X , with the licence number:  D3317 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X , with the licence number: D3317 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4110720 . This is a "AETNA PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 86463K . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1386534-10 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10013094 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1386534-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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