{
"Npi": {
"NPI": "1063875490",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MULLOY",
"FirstName": "EVAN",
"MiddleName": "ANTHONY",
"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": "9110 E NICHOLS AVE STE 150",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CENTENNIAL",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80112-3450",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "720-666-4739",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1400 N COIT RD STE 302",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MCKINNEY",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75071-6656",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "469-722-5700",
"PracticeLocationAddressFaxNumber": "833-449-4351",
"EnumerationDate": "04/02/2016",
"LastUpdateDate": "10/24/2025",
"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": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "42945",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "92615",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "E-17677",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "70636",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "ME167214",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "340289",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "U8100",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "171780",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "34075",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "DR.0072249",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}