1831192319 NPI number — DR. JAMAL A RAZZACK M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831192319 NPI number — DR. JAMAL A RAZZACK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAZZACK
Provider First Name:
JAMAL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
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:
RAZZACK
Provider Other First Name:
JAMAL
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831192319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10837 KATY FREEWAY
Provider Second Line Business Mailing Address:
STE. 250
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77079-2205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-464-8098
Provider Business Mailing Address Fax Number:
713-465-1921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10837 KATY FREEWAY
Provider Second Line Business Practice Location Address:
STE. 250
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77079-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-464-8098
Provider Business Practice Location Address Fax Number:
713-465-1921
Provider Enumeration Date:
05/27/2005

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: 207RP1001X , with the licence number:  K4205 , 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: 151461401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1819788 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3761270 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1629103221 . This is a "MEMORIAL PULMONARY AND SLEEP DISORDERS ASSOCIATES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1831192319 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10023338 . This is a "AMERIGROUP TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 290014706 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0050KA . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5672615 . This is a "AETNAHEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8539B0 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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