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1184264764 NPI number — GIRMA MOGES GAMME M.D.

NPI Number: 1184264764
Health Care Provider/Practitioner: GIRMA MOGES GAMME M.D.

Information about “1184264764” NPI (GIRMA MOGES GAMME M.D.) exists in 1184264764 in HTML format HTML  |  1184264764 in plain Text format TXT  |  1184264764 in PDF (Portable Document Format) PDF  |  1184264764 in an XML format XML  formats.

NPI Number : 1184264764 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184264764",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GAMME",
    "FirstName": "GIRMA",
    "MiddleName": "MOGES",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1120 NW 14TH ST FL 4",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIAMI",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33136-2107",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "DON SOFFER CLINICAL RESEARCH BUILDING",
    "SecondLinePracticeLocationAddress": "1120 NW 14TH STREET - 4TH FLOOR",
    "PracticeLocationAddressCityName": "MIAMI",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33136",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-686-7679",
    "PracticeLocationAddressFaxNumber": "631-686-6925",
    "EnumerationDate": "01/10/2020",
    "LastUpdateDate": "01/06/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "12/08/2020",
    "NPIReactivationDate": "11/07/2022",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "302170",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "ME159498",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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