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1043043565 NPI number — SAMUEL TAMAYO FERNANDEZ JR. DDS

NPI Number: 1043043565
Health Care Provider/Practitioner: SAMUEL TAMAYO FERNANDEZ JR. DDS

Information about “1043043565” NPI (SAMUEL TAMAYO FERNANDEZ JR. DDS) exists in 1043043565 in HTML format HTML  |  1043043565 in plain Text format TXT  |  1043043565 in PDF (Portable Document Format) PDF  |  1043043565 in an XML format XML  formats.

NPI Number : 1043043565 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043043565",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FERNANDEZ",
    "FirstName": "SAMUEL",
    "MiddleName": "TAMAYO",
    "NamePrefix": "DR.",
    "NameSuffix": "JR.",
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FERNANDEZ",
    "OtherFirstName": "SAM",
    "OtherMiddleName": "TAMAYO",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": "JR.",
    "OtherCredential": "DDS",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "7900 E PRINCESS DR APT 2249",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SCOTTSDALE",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85255-5867",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "224-436-2570",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2805 W AGUA FRIA FWY STE 8A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PHOENIX",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85027-3901",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "623-255-3390",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/21/2024",
    "LastUpdateDate": "08/21/2024",
    "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": "122300000X",
        "TaxonomyName": "Dentist",
        "LicenseNumber": "D012283",
        "LicenseNumberStateCode": "AZ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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