1124192356 NPI number — EAGLE PROFESSIONAL SERVICES, INC.

Table of content: JAMES FULLER LAWSING III M.D. (NPI 1356312169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124192356 NPI number — EAGLE PROFESSIONAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAGLE PROFESSIONAL SERVICES, INC.
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:
1124192356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4150 NW 7TH ST
Provider Second Line Business Mailing Address:
205
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-5535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-643-3661
Provider Business Mailing Address Fax Number:
305-643-3677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 NW 7TH ST
Provider Second Line Business Practice Location Address:
205
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-5535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-643-3661
Provider Business Practice Location Address Fax Number:
305-643-3677
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
DAVIS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-643-3661

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com