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1033136619 NPI number — LUTHER J WILLMORE MD

NPI Number: 1033136619
Health Care Provider/Practitioner: LUTHER J WILLMORE MD

Information about “1033136619” NPI (LUTHER J WILLMORE MD) exists in 1033136619 in HTML format HTML  |  1033136619 in plain Text format TXT  |  1033136619 in PDF (Portable Document Format) PDF  |  1033136619 in an XML format XML  formats.

NPI Number : 1033136619 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033136619",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILLMORE",
    "FirstName": "LUTHER",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1008 SOUTH SPRING",
    "SecondLineMailingAddress": "PROVIDER ENROLLMENT",
    "MailingAddressCityName": "ST LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63110",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-977-4440",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1225 S GRAND BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63104-1016",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-977-6082",
    "PracticeLocationAddressFaxNumber": "314-977-6086",
    "EnumerationDate": "07/17/2006",
    "LastUpdateDate": "10/28/2020",
    "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": "2084N0600X",
          "TaxonomyName": "Clinical Neurophysiology Physician",
          "LicenseNumber": "31757",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084N0400X",
          "TaxonomyName": "Neurology Physician",
          "LicenseNumber": "31757",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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