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1023054343 NPI number — MALCOLM ROGER BURDICK PHD

NPI Number: 1023054343
Health Care Provider/Practitioner: MALCOLM ROGER BURDICK PHD

Information about “1023054343” NPI (MALCOLM ROGER BURDICK PHD) exists in 1023054343 in HTML format HTML  |  1023054343 in plain Text format TXT  |  1023054343 in PDF (Portable Document Format) PDF  |  1023054343 in an XML format XML  formats.

NPI Number : 1023054343 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023054343",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BURDICK",
    "FirstName": "MALCOLM",
    "MiddleName": "ROGER",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "661 BROOKSIDE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CEDAR HILL",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75104-4710",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "972-291-8368",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8059 SCYENE CIR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75227-5562",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "800-257-8715",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/22/2006",
    "LastUpdateDate": "07/08/2007",
    "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": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "22091",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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