1396718516 NPI number — DR. JULIUS HENRY VAN BAVEL M.D.

Table of content: DR. JULIUS HENRY VAN BAVEL M.D. (NPI 1396718516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396718516 NPI number — DR. JULIUS HENRY VAN BAVEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN BAVEL
Provider First Name:
JULIUS
Provider Middle Name:
HENRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VANBAVEL
Provider Other First Name:
JAY
Provider Other Middle Name:
HENRY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1396718516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3410 FAR WEST BLVD
Provider Second Line Business Mailing Address:
146
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-3194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-349-0777
Provider Business Mailing Address Fax Number:
512-349-9111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3410 FAR WEST BLVD
Provider Second Line Business Practice Location Address:
146
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78731-3194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-349-0777
Provider Business Practice Location Address Fax Number:
512-349-9111
Provider Enumeration Date:
02/08/2006

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: 207KA0200X , with the licence number:  G0228 , 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)





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