1366476921 NPI number — JOHN G ORFANOS MD

Table of content: JOHN G ORFANOS MD (NPI 1366476921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366476921 NPI number — JOHN G ORFANOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORFANOS
Provider First Name:
JOHN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1366476921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2975
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78502-2975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-362-8170
Provider Business Mailing Address Fax Number:
956-362-8168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 E DOVE AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-628-1709
Provider Business Practice Location Address Fax Number:
956-362-8168
Provider Enumeration Date:
07/10/2006

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: 2086S0127X , with the licence number:  G9780 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: G9780 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: G9780 , 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: 020047898 . This is a "RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0032PA . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00244237 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: G9780 . This is a "TEXAS STATE BOARD OF MEDI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 126615710 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126615703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126615706 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126615707 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126615708 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126615709 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126615711 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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