{
"Npi": {
"NPI": "1063075687",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GENDI",
"FirstName": "MARK",
"MiddleName": "WAGIH",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DO",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 909",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40201-0909",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "502-588-0328",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "17198 ST LUKES WAY STE 600",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "THE WOODLANDS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77384-8017",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "936-266-2650",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/18/2019",
"LastUpdateDate": "07/14/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "04/18/2019",
"NPIReactivationDate": "05/01/2019",
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
"LicenseNumber": "05886",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207XS0114X",
"TaxonomyName": "Adult Reconstructive Orthopaedic Surgery Physician",
"LicenseNumber": "V9902",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
"LicenseNumber": "V9902",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}