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1245425230 NPI number — JACOB THEODORE BROWN JR. PH.D.

NPI Number: 1245425230
Health Care Provider/Practitioner: JACOB THEODORE BROWN JR. PH.D.

Information about “1245425230” NPI (JACOB THEODORE BROWN JR. PH.D.) exists in 1245425230 in HTML format HTML  |  1245425230 in plain Text format TXT  |  1245425230 in PDF (Portable Document Format) PDF  |  1245425230 in an XML format XML  formats.

NPI Number : 1245425230 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245425230",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROWN",
    "FirstName": "JACOB",
    "MiddleName": "THEODORE",
    "NamePrefix": "DR.",
    "NameSuffix": "JR.",
    "Credential": "PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BROWN",
    "OtherFirstName": "J.",
    "OtherMiddleName": "THEODORE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": "JR.",
    "OtherCredential": "PH.D.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "7950 CROSSROADS DR",
    "SecondLineMailingAddress": "607",
    "MailingAddressCityName": "NORTH CHARLESTON",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29406-9411",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "843-576-4254",
    "MailingAddressFaxNumber": "800-479-2209",
    "FirstLinePracticeLocationAddress": "7950 CROSSROADS DR",
    "SecondLinePracticeLocationAddress": "607",
    "PracticeLocationAddressCityName": "NORTH CHARLESTON",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29406-9411",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-576-4254",
    "PracticeLocationAddressFaxNumber": "800-479-2209",
    "EnumerationDate": "09/12/2007",
    "LastUpdateDate": "09/12/2007",
    "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": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "1006",
        "LicenseNumberStateCode": "SC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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