{
"Npi": {
"NPI": "1023050200",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PAKPREO",
"FirstName": "PONRAT",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 421",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LIBERTY LAKE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "99019-0421",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "509-893-8140",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "16528 E DESMET CT STE B-1000",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPOKANE VALLEY",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "99216-3522",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "509-944-8860",
"PracticeLocationAddressFaxNumber": "509-944-8856",
"EnumerationDate": "06/12/2006",
"LastUpdateDate": "01/13/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "224294",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "MD00047151",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2080A0000X",
"TaxonomyName": "Pediatric Adolescent Medicine Physician",
"LicenseNumber": "224294",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2080A0000X",
"TaxonomyName": "Pediatric Adolescent Medicine Physician",
"LicenseNumber": "MD00047151",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}