1801883822 NPI number — DR. AVTAR T GHUMAN MD

Table of content: DR. AVTAR T GHUMAN MD (NPI 1801883822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801883822 NPI number — DR. AVTAR T GHUMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHUMAN
Provider First Name:
AVTAR
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
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:
1801883822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6901 INTERNATIONAL CENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33912-7125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-939-4323
Provider Business Mailing Address Fax Number:
239-939-3983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6901 INTERNATIONAL CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33912-7125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-939-4323
Provider Business Practice Location Address Fax Number:
239-939-3983
Provider Enumeration Date:
10/04/2005

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: 207W00000X , with the licence number:  ME0080678 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME0080678 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: ME80678 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 374440000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA7010 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 259519200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180041380 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 259519200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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