1871979674 NPI number — MR. STEVEN ROBERT SOUDERS PA-C

Table of content: MR. STEVEN ROBERT SOUDERS PA-C (NPI 1871979674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871979674 NPI number — MR. STEVEN ROBERT SOUDERS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUDERS
Provider First Name:
STEVEN
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1871979674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1417 GABLES CT STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75075-7648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-326-5115
Provider Business Mailing Address Fax Number:
469-326-5119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 HIGHWAY 121 STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEYVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76034-5929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-502-7411
Provider Business Practice Location Address Fax Number:
817-502-7412
Provider Enumeration Date:
08/04/2015

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: 363A00000X , 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: 8874NV . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com