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1265410229 NPI number — MONA S MANGE M.D.

NPI Number: 1265410229
Health Care Provider/Practitioner: MONA S MANGE M.D.

Information about “1265410229” NPI (MONA S MANGE M.D.) exists in 1265410229 in HTML format HTML  |  1265410229 in plain Text format TXT  |  1265410229 in PDF (Portable Document Format) PDF  |  1265410229 in an XML format XML  formats.

NPI Number : 1265410229 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265410229",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MANGE",
    "FirstName": "MONA",
    "MiddleName": "S",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "STEPHAN",
    "OtherFirstName": "MONA",
    "OtherMiddleName": "J",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3931 E 98TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TULSA",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "74137-5202",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "918-299-2389",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3931 E 98TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TULSA",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "74137-5202",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "918-299-2389",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/09/2006",
    "LastUpdateDate": "09/01/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208000000X",
        "TaxonomyName": "Pediatrics Physician",
        "LicenseNumber": "12981",
        "LicenseNumberStateCode": "OK",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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