Basic Information
Provider Information
NPI: 1730539289
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ORR
FirstName: JAY
MiddleName: STEVEN
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1504 TAUB LOOP
Address2:  
City: HOUSTON
State: TX
PostalCode: 770301608
CountryCode: US
TelephoneNumber: 7137981750
FaxNumber: 7137984693
Practice Location
Address1: 1504 TAUB LOOP
Address2:  
City: HOUSTON
State: TX
PostalCode: 770301608
CountryCode: US
TelephoneNumber: 7137981750
FaxNumber: 7137984693
Other Information
ProviderEnumerationDate: 06/15/2016
LastUpdateDate: 05/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XD87411MDN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X0116029423VAN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XT2940TXY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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