1669738522 NPI number — JOBY THEKKUMKEL JAMES M.D.

Table of content: JOBY THEKKUMKEL JAMES M.D. (NPI 1669738522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669738522 NPI number — JOBY THEKKUMKEL JAMES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMES
Provider First Name:
JOBY
Provider Middle Name:
THEKKUMKEL
Provider Name Prefix Text:
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:
THEKKUMKEL
Provider Other First Name:
JOBY
Provider Other Middle Name:
JAMES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669738522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 INDEPENDENCE PKWY
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75023-5463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-596-1747
Provider Business Mailing Address Fax Number:
972-985-9775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5501 INDEPENDENCE PKWY
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75023-5463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-596-1747
Provider Business Practice Location Address Fax Number:
972-985-9775
Provider Enumeration Date:
04/05/2012

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: 207R00000X , with the licence number:  29122 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: R1548 , 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: 567020YNGS , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 567020YL7A , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 567020YL7B , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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