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1144753492 NPI number — CREIGHTON WOOLSEY DPM

NPI Number: 1144753492
Health Care Provider/Practitioner: CREIGHTON WOOLSEY DPM

Information about “1144753492” NPI (CREIGHTON WOOLSEY DPM) exists in 1144753492 in HTML format HTML  |  1144753492 in plain Text format TXT  |  1144753492 in PDF (Portable Document Format) PDF  |  1144753492 in an XML format XML  formats.

NPI Number : 1144753492 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1144753492",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WOOLSEY",
    "FirstName": "CREIGHTON",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPM",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1155 W PARKVIEW ST STE 2J",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOLIVAR",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65613-8598",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "417-328-7000",
    "MailingAddressFaxNumber": "417-328-1142",
    "FirstLinePracticeLocationAddress": "1155 W PARKVIEW ST STE 2J",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOLIVAR",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "65613-8598",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "417-328-7000",
    "PracticeLocationAddressFaxNumber": "417-328-1142",
    "EnumerationDate": "04/04/2017",
    "LastUpdateDate": "09/21/2020",
    "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": "213ES0103X",
        "TaxonomyName": "Foot & Ankle Surgery Podiatrist",
        "LicenseNumber": "2020015348",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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