1003014168 NPI number — JOHN M ELLIOTT C.S.F.A./D.O./PH.D.

NPI Number: 1003014168
Health Care Provider/Practitioner: JOHN M ELLIOTT C.S.F.A./D.O./PH.D.

NPI Number : 1003014168 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003014168",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLIOTT",
    "FirstName": "JOHN",
    "MiddleName": "M",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "C.S.F.A./D.O./PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3201 MID DALE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOUISVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40220-2615",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "502-599-5778",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2150 S CENTRAL EXPY STE 130",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MCKINNEY",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75070-4068",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "972-363-8200",
    "PracticeLocationAddressFaxNumber": "972-363-8195",
    "EnumerationDate": "07/10/2007",
    "LastUpdateDate": "09/09/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "246ZC0007X",
          "TaxonomyName": "Surgical Assistant",
          "LicenseNumber": "107788",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "246ZC0007X",
          "TaxonomyName": "Surgical Assistant",
          "LicenseNumber": "SA170",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175L00000X",
          "TaxonomyName": "Homeopath",
          "LicenseNumber": "FFF/11/296",
          "LicenseNumberStateCode": "ZZ",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}