1013991991 NPI number — MR. DOUGLAS HERBERT DUMAS MPT

Table of content: MR. DOUGLAS HERBERT DUMAS MPT (NPI 1013991991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013991991 NPI number — MR. DOUGLAS HERBERT DUMAS MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUMAS
Provider First Name:
DOUGLAS
Provider Middle Name:
HERBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MPT
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:
1013991991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EDIS, NAVAL AIR FACILITY
Provider Second Line Business Mailing Address:
BLDG 94 UNIT 5048
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96319
Provider Business Mailing Address Country Code:
JP
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIS, NAVAL AIR FACILITY
Provider Second Line Business Practice Location Address:
BLDG 94 UNIT 5048
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96319
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
2269039
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2005

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: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1098606 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com