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1023303682 NPI number — ROBERT BLAKE BROCKWELL

NPI Number: 1023303682
Health Care Provider/Practitioner: ROBERT BLAKE BROCKWELL

Information about “1023303682” NPI (ROBERT BLAKE BROCKWELL) exists in 1023303682 in HTML format HTML  |  1023303682 in plain Text format TXT  |  1023303682 in PDF (Portable Document Format) PDF  |  1023303682 in an XML format XML  formats.

NPI Number : 1023303682 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023303682",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROCKWELL",
    "FirstName": "ROBERT",
    "MiddleName": "BLAKE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "22218 N 1750 EAST RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DANVILLE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "61834-7456",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "217-260-0688",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "22218 N 1750 EAST RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DANVILLE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "61834-7456",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "217-260-0688",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/12/2011",
    "LastUpdateDate": "06/12/2011",
    "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": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "087172",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183700000X",
          "TaxonomyName": "Pharmacy Technician",
          "LicenseNumber": "049.160038",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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