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1336302801 NPI number — SETH KAGAN MD

NPI Number: 1336302801
Health Care Provider/Practitioner: SETH KAGAN MD

Information about “1336302801” NPI (SETH KAGAN MD) exists in 1336302801 in HTML format HTML  |  1336302801 in plain Text format TXT  |  1336302801 in PDF (Portable Document Format) PDF  |  1336302801 in an XML format XML  formats.

NPI Number : 1336302801 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336302801",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KAGAN",
    "FirstName": "SETH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1613 CAMINO DE LA SIERRA NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALBUQUERQUE",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87112-4937",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "408-673-7384",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3001 BROADMOOR BLVD NE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIO RANCHO",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87144-2100",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-994-7000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/05/2008",
    "LastUpdateDate": "03/12/2025",
    "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": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": "MD2016-0613",
        "LicenseNumberStateCode": "NM",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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