1306018320 NPI number — THOMAS K. W. DRAPER DMD, MD

Table of content: (NPI 1912099649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306018320 NPI number — THOMAS K. W. DRAPER DMD, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRAPER
Provider First Name:
THOMAS
Provider Middle Name:
K. W.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD, MD
Provider Gender Code:
M

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:
1306018320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 S. FM 548
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
FORNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-689-0704
Provider Business Mailing Address Fax Number:
469-689-0709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 S. FM 548
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
FORNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-689-0704
Provider Business Practice Location Address Fax Number:
469-689-0709
Provider Enumeration Date:
03/31/2008

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: 1223S0112X , with the licence number:  B226-X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: 24789 , 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: 288152601 . This is a "FACILITY TPI MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 206992419 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700157146 . This is a "FACILITY NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: OPT0005 . This is a "MEDICARE OPT OUT PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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