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1093783425 NPI number — MARK E. ENDICOTT M.D.

NPI Number: 1093783425
Health Care Provider/Practitioner: MARK E. ENDICOTT M.D.

Information about “1093783425” NPI (MARK E. ENDICOTT M.D.) exists in 1093783425 in HTML format HTML  |  1093783425 in plain Text format TXT  |  1093783425 in PDF (Portable Document Format) PDF  |  1093783425 in an XML format XML  formats.

NPI Number : 1093783425 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093783425",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ENDICOTT",
    "FirstName": "MARK",
    "MiddleName": "E.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2801 K ST 500",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SACRAMENTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95816-5119",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "916-732-3340",
    "MailingAddressFaxNumber": "916-732-3360",
    "FirstLinePracticeLocationAddress": "2801 K STREET",
    "SecondLinePracticeLocationAddress": "SUITE 500",
    "PracticeLocationAddressCityName": "SACRAMENTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95816-5119",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "916-732-3341",
    "PracticeLocationAddressFaxNumber": "916-732-3360",
    "EnumerationDate": "03/10/2006",
    "LastUpdateDate": "02/05/2024",
    "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": "207X00000X",
        "TaxonomyName": "Orthopaedic Surgery Physician",
        "LicenseNumber": "G46261",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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