1932153814 NPI number — GREGORY DAVID DAYTON PHD

Table of content: (NPI 1659489631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932153814 NPI number — GREGORY DAVID DAYTON PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAYTON
Provider First Name:
GREGORY
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1932153814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12012 WICKCHESTER LN
Provider Second Line Business Mailing Address:
SUITE 550
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77079-1229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-448-2800
Provider Business Mailing Address Fax Number:
832-448-2801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12012 WICKCHESTER LN
Provider Second Line Business Practice Location Address:
SUITE 550
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77079-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-448-2800
Provider Business Practice Location Address Fax Number:
832-448-2801
Provider Enumeration Date:
05/22/2006

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: 103TC0700X , with the licence number:  24541 , 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: 8J1062 . This is a "DOMHA MCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00449569 . This is a "DOCS RR MCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 87348A . This is a "DOCS BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8J1589 . This is a "DOCS MCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 87331A . This is a "BCBS DOMHA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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