1235107657 NPI number — DR. JEAN-PIERRE LETELLIER MD

Table of content: DR. JEAN-PIERRE LETELLIER MD (NPI 1235107657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235107657 NPI number — DR. JEAN-PIERRE LETELLIER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LETELLIER
Provider First Name:
JEAN-PIERRE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1235107657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1004 HOBBS HWY
Provider Second Line Business Mailing Address:
STE 4
Provider Business Mailing Address City Name:
SEMINOLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79360-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-758-4960
Provider Business Mailing Address Fax Number:
432-758-4979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 HOBBS HWY
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
SEMINOLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79360-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-758-4960
Provider Business Practice Location Address Fax Number:
432-758-4979
Provider Enumeration Date:
03/10/2006

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: 207Q00000X , with the licence number:  M3003 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: M3003 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0025PT . This is a "BLUE CROSS AND BLUE SHIELD OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 141430 . This is a "SUPERIOR CHIPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 178909105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 178909106 . This is a "MEDICAID HEALTHSTEPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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