1679963409 NPI number — MR. JOSE' RAMON DECLET II PA

Table of content: MR. JOSE' RAMON DECLET II PA (NPI 1679963409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679963409 NPI number — MR. JOSE' RAMON DECLET II PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DECLET
Provider First Name:
JOSE'
Provider Middle Name:
RAMON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DECLET
Provider Other First Name:
JOSE'
Provider Other Middle Name:
RAMON
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
II
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679963409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4250 HWY 202
Provider Second Line Business Mailing Address:
UTMB
Provider Business Mailing Address City Name:
BEEVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-358-9890
Provider Business Mailing Address Fax Number:
361-362-6654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4250 HWY 202
Provider Second Line Business Practice Location Address:
UTMB/GARZA UNIT
Provider Business Practice Location Address City Name:
BEEVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-358-9890
Provider Business Practice Location Address Fax Number:
361-362-6654
Provider Enumeration Date:
02/02/2015

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: 363AM0700X , with the licence number:  PA01526 , 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: PA01526 . This is a "TDCJ STATE PRISON" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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