1740570746 NPI number — MR. DOUGLAS AQUINAS CAGNEY PA-C

Table of content: MR. DOUGLAS AQUINAS CAGNEY PA-C (NPI 1740570746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740570746 NPI number — MR. DOUGLAS AQUINAS CAGNEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAGNEY
Provider First Name:
DOUGLAS
Provider Middle Name:
AQUINAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1740570746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 LAKEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76710-2966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-772-7037
Provider Business Mailing Address Fax Number:
254-776-7188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2403 E WACO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLMEAD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76705-3259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-799-1799
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2011

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: 363A00000X , with the licence number:  PA01520 , 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)





Copyright © 2007-2024 www.npivalidator.com