1609871334 NPI number — DR. WAYNE S MARGOLIS M.D.

Table of content: DR. WAYNE S MARGOLIS M.D. (NPI 1609871334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609871334 NPI number — DR. WAYNE S MARGOLIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARGOLIS
Provider First Name:
WAYNE
Provider Middle Name:
S
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:
MARGOLIS
Provider Other First Name:
WAYNE
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1609871334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77701-4664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-835-4003
Provider Business Mailing Address Fax Number:
409-835-7005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77701-4664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-835-4003
Provider Business Practice Location Address Fax Number:
409-835-7005
Provider Enumeration Date:
06/17/2005

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: 207RC0200X , with the licence number:  F 9775 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: F 9775 , 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: 1493975-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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