1285861674 NPI number — LIXIA ZHAO ELLIS M.D., PH.D.

NPI Number: 1285861674
Health Care Provider/Practitioner: LIXIA ZHAO ELLIS M.D., PH.D.

NPI Number : 1285861674 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285861674",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLIS",
    "FirstName": "LIXIA",
    "MiddleName": "ZHAO",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D., PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ZHAO",
    "OtherFirstName": "LIXIA",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.D., PH.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "140 HOSPITAL DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BENNINGTON",
    "MailingAddressStateName": "VT",
    "MailingAddressPostalCode": "05201-5009",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "802-447-5544",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "100 HOSPITAL DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BENNINGTON",
    "PracticeLocationAddressStateName": "VT",
    "PracticeLocationAddressPostalCode": "05201-5004",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "802-447-5544",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/12/2009",
    "LastUpdateDate": "03/17/2014",
    "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": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "TL-3746",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "042.0012576",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}