Provider Demographics
NPI:1083986715
Name:MIKE CAPT MD PLLC
Entity Type:Organization
Organization Name:MIKE CAPT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-577-7578
Mailing Address - Street 1:22 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-1832
Mailing Address - Country:US
Mailing Address - Phone:806-577-7578
Mailing Address - Fax:
Practice Address - Street 1:300 W HALSELL ST
Practice Address - Street 2:
Practice Address - City:DIMMITT
Practice Address - State:TX
Practice Address - Zip Code:79027-1846
Practice Address - Country:US
Practice Address - Phone:806-577-7578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty