1790784700 NPI number — JODY PINKERTON MD

Table of content: JODY PINKERTON MD (NPI 1790784700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790784700 NPI number — JODY PINKERTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINKERTON
Provider First Name:
JODY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1790784700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16651 SOUTHWEST FWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-2345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-774-5131
Provider Business Mailing Address Fax Number:
713-481-6316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16651 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-2345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-774-5131
Provider Business Practice Location Address Fax Number:
713-481-6316
Provider Enumeration Date:
07/20/2005

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: 207V00000X , with the licence number:  G55731 , 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: 2008929 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3677670-003 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1060287-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160040777 . This is a "MEDICARE RR-SW LOCATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 88W583 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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