1831784354 NPI number — BEDAR STEPHANE DOYLE BSMT/USAR

Table of content: BEDAR STEPHANE DOYLE BSMT/USAR (NPI 1831784354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831784354 NPI number — BEDAR STEPHANE DOYLE BSMT/USAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOYLE
Provider First Name:
BEDAR
Provider Middle Name:
STEPHANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSMT/USAR
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:
1831784354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 551
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77351-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-729-7978
Provider Business Mailing Address Fax Number:
281-596-7574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 N WASHINGTON AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77351-9126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-729-7978
Provider Business Practice Location Address Fax Number:
281-596-7574
Provider Enumeration Date:
03/05/2021

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: 291U00000X , with the licence number:  45D2147203 , 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)





Copyright © 2007-2025 www.npivalidator.com