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1295853802 NPI number — NICANOR D DEVERA MD

NPI Number: 1295853802
Health Care Provider/Practitioner: NICANOR D DEVERA MD

Information about “1295853802” NPI (NICANOR D DEVERA MD) exists in 1295853802 in HTML format HTML  |  1295853802 in plain Text format TXT  |  1295853802 in PDF (Portable Document Format) PDF  |  1295853802 in an XML format XML  formats.

NPI Number : 1295853802 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295853802",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEVERA",
    "FirstName": "NICANOR",
    "MiddleName": "D",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "531 PEBBLE BROOK LN",
    "SecondLineMailingAddress": "HMAI",
    "MailingAddressCityName": "BELLEVILLE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62221-7609",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-779-5508",
    "MailingAddressFaxNumber": "618-206-8588",
    "FirstLinePracticeLocationAddress": "6150 OAKLAND AVE",
    "SecondLinePracticeLocationAddress": "CO MARILYN KORNBERGER",
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63139-3215",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-768-3090",
    "PracticeLocationAddressFaxNumber": "314-768-3031",
    "EnumerationDate": "03/26/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "207P00000X",
        "TaxonomyName": "Emergency Medicine Physician",
        "LicenseNumber": "R8B11",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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