1700957222 NPI number — DR. JOHN B DELCAMBRE M.D.

Table of content: DR. JOHN B DELCAMBRE M.D. (NPI 1700957222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700957222 NPI number — DR. JOHN B DELCAMBRE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELCAMBRE
Provider First Name:
JOHN
Provider Middle Name:
B
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:
1700957222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73070-1330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-307-6668
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 HEALTHPLEX PKWY STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73072-9801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-307-6955
Provider Business Practice Location Address Fax Number:
405-307-6957
Provider Enumeration Date:
11/13/2006

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: 208600000X , with the licence number:  E8425 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 30248 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 49278215 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167769201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 739628 . This is a "MEDICARE - PLAINVIEW" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8A9393 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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