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1053584862 NPI number — RON C GABA MD

NPI Number: 1053584862
Health Care Provider/Practitioner: RON C GABA MD

Information about “1053584862” NPI (RON C GABA MD) exists in 1053584862 in HTML format HTML  |  1053584862 in plain Text format TXT  |  1053584862 in PDF (Portable Document Format) PDF  |  1053584862 in an XML format XML  formats.

NPI Number : 1053584862 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053584862",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GABA",
    "FirstName": "RON",
    "MiddleName": "C",
    "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": "1754 W WELLINGTON AVE",
    "SecondLineMailingAddress": "APARTMENT 3E",
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60657-4045",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-263-2312",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1740 W TAYLOR ST",
    "SecondLinePracticeLocationAddress": "MC 931",
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60612-7232",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-996-0235",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/12/2008",
    "LastUpdateDate": "01/23/2014",
    "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": "2085R0204X",
        "TaxonomyName": "Vascular & Interventional Radiology Physician",
        "LicenseNumber": "036115298",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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