1174891246 NPI number — ADAM DAVID WEGLEIN DO & ASSOCIATES PA

Table of content: DR. SHANDA T FANGMAN DDS (NPI 1275757106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174891246 NPI number — ADAM DAVID WEGLEIN DO & ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAM DAVID WEGLEIN DO & ASSOCIATES 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:
1174891246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27385
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77227-7385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-888-3416
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6800 WEST LOOP S
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
BELLAIRE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77401-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-888-3416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WEGLEIN
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
281-888-3416

Provider Taxonomy Codes

  • Taxonomy code: 207RS0010X , with the licence number:  M5576 , 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)





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