Unknown Individual – Neurological Surgery Physician, NPI 1205811916

Unknown Individual is a healthcare provider. based in Wichita falls, Texas. specializing in Neurological Surgery Physician. They hold a License No. MD.015313 (LA). The NPI Number for Unknown Individual is 1205811916

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205811916
Phone
(940) 764-7236
Address
PO BOX 9261
Deactivation Date
30 June 2021

Doctor Profile

Medical School Name
LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS
Secondary Phone
9407645200
Graduation Year
1979 (47 years ago)
PAC ID
2365459666
Group Practice PAC ID
2163417478
Professional Enrollment ID
I20141201001462
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience27
Completeness75
Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • PO BOX 9261

    WICHITA FALLS, TX 763089261

    Phone: (940) 764-7236

    Fax: (940) 764-7237

    Type: Mailing

  • 4327, Barnett Road, Wichita Falls, Wichita County, Texas, 76310, United States

    WICHITA FALLS, TX 763102303

    Phone: (940) 764-5400

    Fax: (940) 764-5454

    Type: Location

  • 1514 Jefferson Hwy

    New Orleans, LA 701212429

    Phone: (504) 842-4033

    Fax: (504) 842-5078

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 76308)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2163417478View full group profile
NameSpecialtyState
Physician AssistantTX
-TX
Sports Medicine, Family PracticeTX
Cardiovascular Disease (Cardiology)TX
Internal MedicineTX
U R O L O G YTX
Endocrinology, Internal MedicineTX
Nurse PractitionerTX
Orthopedic SurgeryTX
Physician AssistantTX

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1205811916.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Neurological Surgery Physician in this dataset. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Wichita Falls, Texas may find Unknown Individual in results; validate coverage separately.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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