NPI Code Detail JSON Logo

1114208261 NPI number — TOBIAS J MORELAND PA-C

NPI Number: 1114208261
Health Care Provider/Practitioner: TOBIAS J MORELAND PA-C

Information about “1114208261” NPI (TOBIAS J MORELAND PA-C) exists in 1114208261 in HTML format HTML  |  1114208261 in plain Text format TXT  |  1114208261 in PDF (Portable Document Format) PDF  |  1114208261 in an XML format XML  formats.

NPI Number : 1114208261 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114208261",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MORELAND",
    "FirstName": "TOBIAS",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MORELAND",
    "OtherFirstName": "TOBIAS",
    "OtherMiddleName": "J",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "PO BOX 95590",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTH JORDAN",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84095-0590",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-352-9500",
    "MailingAddressFaxNumber": "801-352-7976",
    "FirstLinePracticeLocationAddress": "125 BAPTIST WAY STE 5C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PENSACOLA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32503-2274",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "448-227-6950",
    "PracticeLocationAddressFaxNumber": "850-434-2308",
    "EnumerationDate": "09/02/2011",
    "LastUpdateDate": "09/04/2025",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA9106121",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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