1811133697 NPI number — JORGE GERMAN DARCOURT M.D.

Table of content: JORGE GERMAN DARCOURT M.D. (NPI 1811133697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811133697 NPI number — JORGE GERMAN DARCOURT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARCOURT
Provider First Name:
JORGE
Provider Middle Name:
GERMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1811133697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16659 SOUTHWEST FWY
Provider Second Line Business Mailing Address:
SUITE 151
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-2375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-276-5200
Provider Business Mailing Address Fax Number:
281-276-5201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16659 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 151
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-2375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-276-5200
Provider Business Practice Location Address Fax Number:
281-276-5201
Provider Enumeration Date:
12/27/2008

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: 207RH0003X , with the licence number:  M4751 , 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: 204293904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8L14250 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1811133697 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01120352 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 204293903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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