1689692105 NPI number — DR. JAMES W FLESHMAN JR. MD

Table of content: DR. JAMES W FLESHMAN JR. MD (NPI 1689692105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689692105 NPI number — DR. JAMES W FLESHMAN JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLESHMAN
Provider First Name:
JAMES
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
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:
1689692105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 GASTON AVE
Provider Second Line Business Mailing Address:
1ST FLOOR ROBERTS HOSPITAL
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75246-2017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-820-2404
Provider Business Mailing Address Fax Number:
214-820-4538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3409 WORTH STREET, WORTH TOWER
Provider Second Line Business Practice Location Address:
SUITE 640
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-800-7180
Provider Business Practice Location Address Fax Number:
469-800-7190
Provider Enumeration Date:
07/17/2006

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: 208C00000X , with the licence number:  R7B36 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208C00000X , with the licence number: P4647 , 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: 3130585-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3130585-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1689692105 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 202430716 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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