1306992094 NPI number — JERRY L. HYATT, M.D. P.A.

Table of content: (NPI 1306992094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306992094 NPI number — JERRY L. HYATT, M.D. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERRY L. HYATT, M.D. P.A.
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:
6
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:
1306992094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 LAWRENCE
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
TOMBALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77375-3331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-357-1600
Provider Business Mailing Address Fax Number:
281-357-1603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 LAWRENCE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77375-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-357-1600
Provider Business Practice Location Address Fax Number:
281-357-1603
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HYATT
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-357-1600

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  E7626 , 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: E7626 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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