1548378052 NPI number — ERIC J DARROW MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548378052 NPI number — ERIC J DARROW MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DARROW

Provider First Name:

ERIC

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1548378052

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/03/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 99371

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FORT WORTH

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

76199-0371

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

682-885-1855

Provider Business Mailing Address Fax Number:

682-885-7347

Provider First Line Business Practice Location Address:

801 7TH AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FORT WORTH

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

76104-2733

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

682-885-4054

Provider Business Practice Location Address Fax Number:

682-885-7497

Provider Enumeration Date:

08/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207L00000X , with the licence number:  J3301 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207LP3000X , with the licence number: J3301 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 111258100 . This is a "FIRSTCARE PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 138837316 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 1393071 . This is a "UHC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 1416690 . This is a "FIRSTHEALTH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 10033949 . This is a "AMERIGROUP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 5340683 . This is a "CIGNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 5932194 . This is a "AETNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 124116 . This is a "SUPERIOR PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 88072G . This is a "BCBSTX IND PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 138837315 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 414768 . This is a "PHCS PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".