1780686303 NPI number — STEVEN T MINOR MD

Table of content: STEVEN T MINOR MD (NPI 1780686303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780686303 NPI number — STEVEN T MINOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINOR
Provider First Name:
STEVEN
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1780686303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 W 38TH ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78705-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-324-3440
Provider Business Mailing Address Fax Number:
512-406-6513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 S CHURCH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOCKHART
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78644-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-504-0860
Provider Business Practice Location Address Fax Number:
512-324-3449
Provider Enumeration Date:
08/12/2005

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: 207RC0000X , with the licence number:  F4289 , 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: 137542011 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137542012 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8FY884 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com