1760587661 NPI number — LAWRENCE A. SHAFRON MD PA

Table of content: (NPI 1760587661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760587661 NPI number — LAWRENCE A. SHAFRON MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE A. SHAFRON MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1760587661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 SAN JACINTO BLVD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76205-7527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-382-8000
Provider Business Mailing Address Fax Number:
940-383-2608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 SAN JACINTO BLVD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76205-7531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-382-8000
Provider Business Practice Location Address Fax Number:
940-383-2608
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAFRON
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
AARON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
940-382-8000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  J1389 , 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: 8AK441 . This is a "BCBS PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com