{
"Npi": {
"NPI": "1205112240",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARK T. KOWAL MD PC",
"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": "1919 LATHROP ST",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "FAIRBANKS",
"MailingAddressStateName": "AK",
"MailingAddressPostalCode": "99701-5937",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "907-451-5507",
"MailingAddressFaxNumber": "907-451-5590",
"FirstLinePracticeLocationAddress": "1919 LATHROP ST",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "FAIRBANKS",
"PracticeLocationAddressStateName": "AK",
"PracticeLocationAddressPostalCode": "99701-5937",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "907-451-5507",
"PracticeLocationAddressFaxNumber": "907-451-5590",
"EnumerationDate": "10/21/2011",
"LastUpdateDate": "12/27/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOWAL",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "TIMOTHY",
"AuthorizedOfficialTitle": "GENERAL SURGEON",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "907-451-5507",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "7319",
"LicenseNumberStateCode": "AK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}