1487763561 NPI number — DR. JAMES JEFFREY BOOP M.D.

Table of content: DR. JAMES JEFFREY BOOP M.D. (NPI 1487763561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487763561 NPI number — DR. JAMES JEFFREY BOOP M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOOP
Provider First Name:
JAMES
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1487763561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2719 81ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79423-2229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-792-0785
Provider Business Mailing Address Fax Number:
806-788-1620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3008 50TH ST
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79413-4130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-0785
Provider Business Practice Location Address Fax Number:
806-788-1620
Provider Enumeration Date:
08/30/2006

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: 207W00000X , with the licence number:  H2993 , 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: 8AD983 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 108891100 . This is a "FIRSTCARE/SOUTHWEST LIFE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 110566004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180040342 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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