1902933690 NPI number — DEAN A. DARR, D.C., P.A.

Table of content: (NPI 1902933690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902933690 NPI number — DEAN A. DARR, D.C., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEAN A. DARR, D.C., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1902933690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
649 S BROADWAY AVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75701-1677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-526-2225
Provider Business Mailing Address Fax Number:
903-526-2413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 ASHLEY RIDGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71106-7228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-526-2225
Provider Business Practice Location Address Fax Number:
903-526-2413
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DARR
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-526-2225

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1420 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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