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1205192432 NPI number — BROCK DONALD LIBBY MD

NPI Number: 1205192432
Health Care Provider/Practitioner: BROCK DONALD LIBBY MD

Information about “1205192432” NPI (BROCK DONALD LIBBY MD) exists in 1205192432 in HTML format HTML  |  1205192432 in plain Text format TXT  |  1205192432 in PDF (Portable Document Format) PDF  |  1205192432 in an XML format XML  formats.

NPI Number : 1205192432 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205192432",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LIBBY",
    "FirstName": "BROCK",
    "MiddleName": "DONALD",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3401 CIVIC CENTER BLVD",
    "SecondLineMailingAddress": "DIVISION OF ADOLESCENT MEDICINE",
    "MailingAddressCityName": "PHILADELPHIA",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19104-4319",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "75 JOHN ROBERTS RD BLDG B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTH PORTLAND",
    "PracticeLocationAddressStateName": "ME",
    "PracticeLocationAddressPostalCode": "04106-6967",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "207-775-4151",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/02/2012",
    "LastUpdateDate": "07/25/2019",
    "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": "208000000X",
        "TaxonomyName": "Pediatrics Physician",
        "LicenseNumber": "MD22819",
        "LicenseNumberStateCode": "ME",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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