1851711659 NPI number — ABBEY MULDER OTR

Table of content: ABBEY MULDER OTR (NPI 1851711659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851711659 NPI number — ABBEY MULDER OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULDER
Provider First Name:
ABBEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
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:
1851711659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 OHIO DR
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-5330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-599-9594
Provider Business Mailing Address Fax Number:
972-599-9364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9301 N. CENTRAL EXPWY.
Provider Second Line Business Practice Location Address:
TOWER 1, STE 340
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-528-6210
Provider Business Practice Location Address Fax Number:
214-528-3885
Provider Enumeration Date:
04/18/2014

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: 225X00000X , with the licence number:  115967 , 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: 115967 . This is a "OT LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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