1962562132 NPI number — JEREMY S MORAN D.P.M

Table of content: JEREMY S MORAN D.P.M (NPI 1962562132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962562132 NPI number — JEREMY S MORAN D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAN
Provider First Name:
JEREMY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
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:
1962562132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24914 TOMBALL PKWY STE 180
Provider Second Line Business Mailing Address:
#140
Provider Business Mailing Address City Name:
TOMBALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77375-5080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-290-0400
Provider Business Mailing Address Fax Number:
281-516-0066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24914 TOMBALL PKWY
Provider Second Line Business Practice Location Address:
#180
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77375-7690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-290-0400
Provider Business Practice Location Address Fax Number:
281-516-0066
Provider Enumeration Date:
12/11/2006

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: 213ES0103X , with the licence number:  1520P , 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: 8300658 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 043774102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0042JW . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1520P . This is a "RX #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7385429 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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