1912192170 NPI number — KARRI D.DUTTON,M.D.,P.A.

Table of content: (NPI 1912192170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912192170 NPI number — KARRI D.DUTTON,M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARRI D.DUTTON,M.D.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIDSCARE
Provider Other Organization Name Type Code:
3
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:
1912192170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3871 LONG PRAIRIE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028-1569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-899-5437
Provider Business Mailing Address Fax Number:
972-899-5447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3871 LONG PRAIRIE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028-1569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-899-5437
Provider Business Practice Location Address Fax Number:
972-899-5447
Provider Enumeration Date:
09/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUTTON
Authorized Official First Name:
KARRI
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-899-5437

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  J6936 , 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: J6936 . This is a "LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1366545709 . This is a "NPI (INDIVIDUAL)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: F64318 . This is a "UPIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".