1487970463 NPI number — DR. MORITZ CASPER WYLER VON BALLMOOS MD/PHD/MPH

Table of content: DR. MORITZ CASPER WYLER VON BALLMOOS MD/PHD/MPH (NPI 1487970463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487970463 NPI number — DR. MORITZ CASPER WYLER VON BALLMOOS MD/PHD/MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WYLER VON BALLMOOS
Provider First Name:
MORITZ
Provider Middle Name:
CASPER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD/PHD/MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WYLER
Provider Other First Name:
MORITZ
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD/PHD/MPH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1487970463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6550 FANNIN ST STE 1401
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:
77030-2738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-441-5200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6550 FANNIN ST STE 1401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-441-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2010

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: 208600000X , with the licence number:  2016-01460 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: R4499 , 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: 379135201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".