1760482640 NPI number — DR. ERWIN LO DR

Table of content: DR. ERWIN LO DR (NPI 1760482640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760482640 NPI number — DR. ERWIN LO DR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LO
Provider First Name:
ERWIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DR
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:
1760482640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6025 METROPOLITAN DR
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77706-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-239-6266
Provider Business Mailing Address Fax Number:
409-898-0177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6025 METROPOLITAN DR
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77706-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-239-6266
Provider Business Practice Location Address Fax Number:
409-898-0177
Provider Enumeration Date:
07/21/2005

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: 174400000X , with the licence number:  L1373 , 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: 150970502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1163373004 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 148913001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8F3763 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A006 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2850217 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00068057 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0020HD . This is a "GROUP BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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