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1306394317 NPI number — LAWRENCE MICHAEL DIMACALI PA-C

NPI Number: 1306394317
Health Care Provider/Practitioner: LAWRENCE MICHAEL DIMACALI PA-C

Information about “1306394317” NPI (LAWRENCE MICHAEL DIMACALI PA-C) exists in 1306394317 in HTML format HTML  |  1306394317 in plain Text format TXT  |  1306394317 in PDF (Portable Document Format) PDF  |  1306394317 in an XML format XML  formats.

NPI Number : 1306394317 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306394317",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DIMACALI",
    "FirstName": "LAWRENCE MICHAEL",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1600 STATE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALEM",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97301-4257",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-540-6300",
    "MailingAddressFaxNumber": "503-540-6404",
    "FirstLinePracticeLocationAddress": "1600 STATE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SALEM",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97301-4257",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-540-6300",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/19/2016",
    "LastUpdateDate": "06/10/2019",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA190503",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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