| Organization Name: | JHONNY MARTIN BAZAN MD PA |
| NPI Number: | 1801122445 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JHONNY MARTIN BAZAN (ADMINISTRATOR) |
| Mailing Address: | 1337 E Palma Vista Dr Ste.a Palmview |
| State: | TX US |
| Postal Code: | 785722055 |
| Phone Number: | 9565199500 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2009 |
| NPI Last Update Date: | 11/01/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |