1265432314 NPI number — GONZALO M VARGAS MD

Table of content: GONZALO M VARGAS MD (NPI 1265432314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265432314 NPI number — GONZALO M VARGAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARGAS
Provider First Name:
GONZALO
Provider Middle Name:
M
Provider Name Prefix Text:
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:
1265432314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77253-3567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-790-5227
Provider Business Mailing Address Fax Number:
713-790-5505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7737 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-776-0655
Provider Business Practice Location Address Fax Number:
713-776-1069
Provider Enumeration Date:
07/29/2005

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: 208G00000X , with the licence number:  F2489 , 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: 89824B . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 128151102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1468354 . This is a "ECFMG" identifier . This identifiers is of the category "OTHER".




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