1275521726 NPI number — DEBORAH SUSAN JONES OD

Table of content: DEBORAH SUSAN JONES OD (NPI 1275521726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275521726 NPI number — DEBORAH SUSAN JONES OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
DEBORAH
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAPALBO
Provider Other First Name:
DEBBY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275521726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 SPANISH TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BASTROP
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78602-3584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-332-0034
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1412 W STATE HIGHWAY 71
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602-3485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-303-5959
Provider Business Practice Location Address Fax Number:
512-332-2332
Provider Enumeration Date:
10/10/2005

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: 152W00000X , with the licence number:  5230TG , 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: 5230TG . This is a "STATE BOARD OF EXAMINERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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