1396365961 NPI number — MR. JOHN MARTIN OLDMIXON LMT, BCTMB

Table of content: MR. JOHN MARTIN OLDMIXON LMT, BCTMB (NPI 1396365961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396365961 NPI number — MR. JOHN MARTIN OLDMIXON LMT, BCTMB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLDMIXON
Provider First Name:
JOHN
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMT, BCTMB
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:
1396365961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 W 34TH ST UNIT 600
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:
77018-6264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-636-5953
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 NORTH LOOP W STE 445
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77008-1363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-703-8787
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MT132768 , 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: 2000268 . This is a "NCBTMB" identifier . This identifiers is of the category "OTHER".
  • Identifier: MT132768 . This is a "TDLR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".