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1366762338 NPI number — WALTER D DISHELL MD A MEDICAL CLINIC

NPI Number: 1366762338
Health Care Provider/Practitioner: WALTER D DISHELL MD A MEDICAL CLINIC

Information about “1366762338” NPI (WALTER D DISHELL MD A MEDICAL CLINIC) exists in 1366762338 in HTML format HTML  |  1366762338 in plain Text format TXT  |  1366762338 in PDF (Portable Document Format) PDF  |  1366762338 in an XML format XML  formats.

NPI Number : 1366762338 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366762338",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WALTER D DISHELL MD A MEDICAL CLINIC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16311 VENTURA BLVD",
    "SecondLineMailingAddress": "SUITE 550",
    "MailingAddressCityName": "ENCINO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91436-2124",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "818-986-7900",
    "MailingAddressFaxNumber": "818-986-7952",
    "FirstLinePracticeLocationAddress": "16311 VENTURA BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 550",
    "PracticeLocationAddressCityName": "ENCINO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91436-2124",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "818-986-7900",
    "PracticeLocationAddressFaxNumber": "818-986-7952",
    "EnumerationDate": "06/01/2010",
    "LastUpdateDate": "09/03/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DISHELL",
    "AuthorizedOfficialFirstName": "WALTER",
    "AuthorizedOfficialMiddleName": "D",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "818-986-7900",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207YS0123X",
        "TaxonomyName": "Facial Plastic Surgery Physician",
        "LicenseNumber": "C274780",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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