NPI Code Detail JSON Logo

1104989169 NPI number — H. MICHAEL ROARK M.D.

NPI Number: 1104989169
Health Care Provider/Practitioner: H. MICHAEL ROARK M.D.

Information about “1104989169” NPI (H. MICHAEL ROARK M.D.) exists in 1104989169 in HTML format HTML  |  1104989169 in plain Text format TXT  |  1104989169 in PDF (Portable Document Format) PDF  |  1104989169 in an XML format XML  formats.

NPI Number : 1104989169 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104989169",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROARK",
    "FirstName": "H.",
    "MiddleName": "MICHAEL",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4104 PALISADES RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN DIEGO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92116-2043",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9850 GENESEE AVE",
    "SecondLinePracticeLocationAddress": "SUITE 130",
    "PracticeLocationAddressCityName": "LA JOLLA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92037-1224",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "858-452-1981",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/19/2006",
    "LastUpdateDate": "12/31/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "10/18/2018",
    "NPIReactivationDate": "12/31/2018",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": "A39651",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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