1568462414 NPI number — DR. ARAX B NAZARIAN DO

Table of content: DR. ARAX B NAZARIAN DO (NPI 1568462414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568462414 NPI number — DR. ARAX B NAZARIAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAZARIAN
Provider First Name:
ARAX
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAZARIAN
Provider Other First Name:
ARAX
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568462414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W MAIN ST
Provider Second Line Business Mailing Address:
#330
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75057-3629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-221-5433
Provider Business Mailing Address Fax Number:
972-436-3832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W MAIN ST
Provider Second Line Business Practice Location Address:
#330
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75057-3629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-221-5433
Provider Business Practice Location Address Fax Number:
972-436-3832
Provider Enumeration Date:
07/21/2005

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: 207V00000X , with the licence number:  J8444 , 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: 042958105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042958106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8CA717 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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