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1144292202 NPI number — WALTER SMITHWICK IV MD

NPI Number: 1144292202
Health Care Provider/Practitioner: WALTER SMITHWICK IV MD

Information about “1144292202” NPI (WALTER SMITHWICK IV MD) exists in 1144292202 in HTML format HTML  |  1144292202 in plain Text format TXT  |  1144292202 in PDF (Portable Document Format) PDF  |  1144292202 in an XML format XML  formats.

NPI Number : 1144292202 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144292202",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SMITHWICK",
    "FirstName": "WALTER",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": "IV",
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2535 RIVERSIDE AVENUE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JACKSONVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32204-4710",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-388-6548",
    "MailingAddressFaxNumber": "904-389-8157",
    "FirstLinePracticeLocationAddress": "2535 RIVERSIDE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSONVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32204-4710",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-388-6548",
    "PracticeLocationAddressFaxNumber": "904-389-8157",
    "EnumerationDate": "02/03/2006",
    "LastUpdateDate": "01/16/2019",
    "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": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "75330",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "ME75330",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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