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1124414693 NPI number — MATTHEW PRESTON RAINBOLT PA-C

NPI Number: 1124414693
Health Care Provider/Practitioner: MATTHEW PRESTON RAINBOLT PA-C

Information about “1124414693” NPI (MATTHEW PRESTON RAINBOLT PA-C) exists in 1124414693 in HTML format HTML  |  1124414693 in plain Text format TXT  |  1124414693 in PDF (Portable Document Format) PDF  |  1124414693 in an XML format XML  formats.

NPI Number : 1124414693 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124414693",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RAINBOLT",
    "FirstName": "MATTHEW",
    "MiddleName": "PRESTON",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 51131",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAFAYETTE",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "70505-1131",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "337-349-6708",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3619 DESERT ROSE LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKE HAVASU CITY",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "86404-1748",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "337-349-6708",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/12/2015",
    "LastUpdateDate": "11/15/2022",
    "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": "6039",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "0010-05706",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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