{
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"NPI": "1225575103",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "JD GLOVER, PLLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
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"FirstLineMailingAddress": "17745 GRAMA RDG",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLORADO SPRINGS",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80908-1360",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-797-3560",
"MailingAddressFaxNumber": "719-362-1102",
"FirstLinePracticeLocationAddress": "1840 DEER CREEK RD",
"SecondLinePracticeLocationAddress": "SUITE 101",
"PracticeLocationAddressCityName": "MONUMENT",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80132-9089",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "719-344-2789",
"PracticeLocationAddressFaxNumber": "719-362-1102",
"EnumerationDate": "01/30/2017",
"LastUpdateDate": "01/30/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GLOVER",
"AuthorizedOfficialFirstName": "JAMIE",
"AuthorizedOfficialMiddleName": "DAHLGREN",
"AuthorizedOfficialTitle": "FOUNDER/SOLO PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "850-797-3560",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "51890",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}