1902813207 NPI number — DR. JEFFREY S WEISLOW D.C.

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 1902813207 NPI number — DR. JEFFREY S WEISLOW D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISLOW
Provider First Name:
JEFFREY
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.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:
1902813207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1722 N ZARAGOZA RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79936-8032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-593-1330
Provider Business Mailing Address Fax Number:
915-921-7702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1722 N ZARAGOZA RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79936-8032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-593-1330
Provider Business Practice Location Address Fax Number:
915-921-7702
Provider Enumeration Date:
08/01/2006

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: 111N00000X , with the licence number:  2948 , 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: 001191801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 601229 . This is a "BC/BS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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