1164432555 NPI number — HOWARD D DEAR M.D.

Table of content: HOWARD D DEAR M.D. (NPI 1164432555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164432555 NPI number — HOWARD D DEAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEAR
Provider First Name:
HOWARD
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1164432555
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 BAPTIST DR
Provider Second Line Business Mailing Address:
#304
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39110-2009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-605-3531
Provider Business Mailing Address Fax Number:
601-605-3532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 BAPTIST DR
Provider Second Line Business Practice Location Address:
#304
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39110-2009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-605-3531
Provider Business Practice Location Address Fax Number:
601-605-3532
Provider Enumeration Date:
08/08/2006

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: 207RC0000X , with the licence number:  04974 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4239272 . This is a "AETNA" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00115735 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 753068151011 . This is a "TRICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: P00417794 . This is a "RR MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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