{
"Npi": {
"NPI": "1174793533",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SHAFFER RAINEY DERMATOLOGY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "110 BUSINESS PARK DRIVE",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "BRANSON",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "65616-8156",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "417-239-0125",
"MailingAddressFaxNumber": "417-239-0125",
"FirstLinePracticeLocationAddress": "110 BUSINESS PARK DR STE C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRANSON",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "65616-7426",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "417-239-0125",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/01/2008",
"LastUpdateDate": "07/06/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RAINEY",
"AuthorizedOfficialFirstName": "CHRISTY",
"AuthorizedOfficialMiddleName": "SHAFFER",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "417-239-0125",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "2007035572",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}