1184626145 NPI number — DR. BRIAN JANSSEN M.D.

Table of content: DR. BRIAN JANSSEN M.D. (NPI 1184626145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184626145 NPI number — DR. BRIAN JANSSEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JANSSEN
Provider First Name:
BRIAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1184626145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 840853
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-0853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-233-1999
Provider Business Mailing Address Fax Number:
972-233-3666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12222 MERIT DR STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75251-3294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-715-5000
Provider Business Practice Location Address Fax Number:
972-715-9976
Provider Enumeration Date:
06/02/2005

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: 207L00000X , with the licence number:  J7016 , 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: 110754209 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110754205 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110754207 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8A1504 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 110754204 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8EH338 . This is a "BCBS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 110754206 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110754208 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00719367 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".




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