1518988104 NPI number — DR. BRIJESH KAPOOR M.D.

Table of content: DR. BRIJESH KAPOOR M.D. (NPI 1518988104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518988104 NPI number — DR. BRIJESH KAPOOR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAPOOR
Provider First Name:
BRIJESH
Provider Middle Name:
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:
1518988104
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16620 N US HIGHWAY 281
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78232-2327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-614-1231
Provider Business Mailing Address Fax Number:
210-616-0704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11481 TOEPPERWEIN RD
Provider Second Line Business Practice Location Address:
SUITE 1202
Provider Business Practice Location Address City Name:
LIVE OAK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78233-3145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-655-8470
Provider Business Practice Location Address Fax Number:
210-967-0276
Provider Enumeration Date:
07/21/2006

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: 207RN0300X , with the licence number:  M7316 , 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: 8J6713 . This is a "MEDIARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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