1396962494 NPI number — DAVID K FLETCHER MD PA

Table of content: (NPI 1396962494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396962494 NPI number — DAVID K FLETCHER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID K FLETCHER MD PA
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:
1396962494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
816 S FLEISHEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75701-2016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-592-2999
Provider Business Mailing Address Fax Number:
903-593-5190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
816 S FLEISHEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75701-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-592-2999
Provider Business Practice Location Address Fax Number:
903-593-5190
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BELL
Authorized Official First Name:
FRANCENE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MGR
Authorized Official Telephone Number:
903-592-2999

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  C8971 , 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: 161781301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0036KV . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DA5689 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00063511 . This is a "RAILROAD MEDICARE INDIVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com