1043315542 NPI number — JACINTO ZAMBRANO JR. M.D.

Table of content: NOAH EIDEMILLER (NPI 1437846300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043315542 NPI number — JACINTO ZAMBRANO JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAMBRANO
Provider First Name:
JACINTO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
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:
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:
1043315542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 HEALTHPLEX PKWY # 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73072-9738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-307-6955
Provider Business Mailing Address Fax Number:
830-258-7098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 HEALTHPLEX PKWY # 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73072-9738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
53-076-9554
Provider Business Practice Location Address Fax Number:
405-307-6957
Provider Enumeration Date:
09/13/2006

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: 2083P0011X , with the licence number:  F2138 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083P0011X , with the licence number: 35451 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: F2138 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 35451 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 127511707 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".