1245923325 NPI number — MJMD PRIMARY CARE AND AESTHETIC MEDICINE CORP

Table of content: (NPI 1245923325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245923325 NPI number — MJMD PRIMARY CARE AND AESTHETIC MEDICINE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MJMD PRIMARY CARE AND AESTHETIC MEDICINE CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1245923325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 LONGWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75013-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-550-4997
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3721 S STONEBRIDGE DR UNIT 703
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75070-0234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-548-4995
Provider Business Practice Location Address Fax Number:
855-592-2912
Provider Enumeration Date:
06/02/2023

Additional Information

Authorized Official

Authorized Official Last Name:
JUBORI
Authorized Official First Name:
MAYSSARA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-550-4997

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com