1417949116 NPI number — DR. LAWRENCE RICHARD BREITKREUTZ JR. M.D.

Table of content: (NPI 1124110218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417949116 NPI number — DR. LAWRENCE RICHARD BREITKREUTZ JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREITKREUTZ
Provider First Name:
LAWRENCE
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
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:
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:
1417949116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 N 18TH ST
Provider Second Line Business Mailing Address:
STE. 401
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79601-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-670-4560
Provider Business Mailing Address Fax Number:
325-670-4559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1680 ANTILLEY RD
Provider Second Line Business Practice Location Address:
STE. 260
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79606-5267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-691-5590
Provider Business Practice Location Address Fax Number:
325-691-1231
Provider Enumeration Date:
08/18/2005

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: 208G00000X , with the licence number:  J7916 , 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: 0971400-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com