1457314536 NPI number — TERRY KEITH GEMAS M.D.

Table of content: KATHRYN ELIZABETH COLE (NPI 1770204729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457314536 NPI number — TERRY KEITH GEMAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEMAS
Provider First Name:
TERRY
Provider Middle Name:
KEITH
Provider Name Prefix Text:
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:
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:
1457314536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1130 BEACHVIEW ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75218-3700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-341-5676
Provider Business Mailing Address Fax Number:
469-341-5677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 BEACHVIEW ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75218-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-341-5676
Provider Business Practice Location Address Fax Number:
469-341-5677
Provider Enumeration Date:
04/10/2006

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: 207X00000X , with the licence number:  L2276 , 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: 7081295 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 610541200 . This is a "DEPARTMENT OD LABOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5475440001 . This is a "PALMETTO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8CM465 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00035Z . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: MDL2276 . This is a "WORK COMP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 151314502 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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