Basic Information
Provider Information | |||||||||
NPI: | 1710998463 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALTUG | ||||||||
FirstName: | SEZEN | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1015 MEDICAL CENTER BLVD | ||||||||
Address2: | SUITE 1700 | ||||||||
City: | WEBSTER | ||||||||
State: | TX | ||||||||
PostalCode: | 775984011 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2814806264 | ||||||||
FaxNumber: | 2814804046 | ||||||||
Practice Location | |||||||||
Address1: | 1015 MEDICAL CENTER BLVD | ||||||||
Address2: | SUITE 1700 | ||||||||
City: | WEBSTER | ||||||||
State: | TX | ||||||||
PostalCode: | 775984052 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2814806264 | ||||||||
FaxNumber: | 2814804046 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/10/2006 | ||||||||
LastUpdateDate: | 10/20/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | J2860 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
ID | Type | State | Issuer | Description | 5250438 | 01 | TX | AETNA | OTHER | 5425 | 01 | TX | MHHNP PROVIDER # | OTHER | 10041730 | 01 | TX | AMERIGROUP PROVIDER # | OTHER | 8K6292 | 01 | TX | BCBS PROVIDER NUMBER | OTHER | 043765902 | 05 | TX |   | MEDICAID |