1336393693 NPI number — JOHN M STURGEON MD, P.A.

Table of content: (NPI 1336393693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336393693 NPI number — JOHN M STURGEON MD, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN M STURGEON MD, P.A.
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:
1336393693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6112 EMMAS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEYVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-676-1044
Provider Business Mailing Address Fax Number:
817-576-4220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6112 EMMAS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEYVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-676-1044
Provider Business Practice Location Address Fax Number:
817-576-4220
Provider Enumeration Date:
11/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STURGEON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
214-676-1044

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  K9911 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: K9911 , 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: 0A0256 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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