NPI Code Detail JSON Logo

1376709949 NPI number — RENATO MANUEL CABALLERO III MD

NPI Number: 1376709949
Health Care Provider/Practitioner: RENATO MANUEL CABALLERO III MD

Information about “1376709949” NPI (RENATO MANUEL CABALLERO III MD) exists in 1376709949 in HTML format HTML  |  1376709949 in plain Text format TXT  |  1376709949 in PDF (Portable Document Format) PDF  |  1376709949 in an XML format XML  formats.

NPI Number : 1376709949 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376709949",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CABALLERO",
    "FirstName": "RENATO",
    "MiddleName": "MANUEL",
    "NamePrefix": null,
    "NameSuffix": "III",
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 785",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAWTON",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "73502-0785",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "580-357-9984",
    "MailingAddressFaxNumber": "580-357-3277",
    "FirstLinePracticeLocationAddress": "3201 W GORE BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 301",
    "PracticeLocationAddressCityName": "LAWTON",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "73505",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "580-248-8225",
    "PracticeLocationAddressFaxNumber": "580-248-8919",
    "EnumerationDate": "08/04/2008",
    "LastUpdateDate": "03/01/2018",
    "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": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "26632",
          "LicenseNumberStateCode": "OK",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208M00000X",
          "TaxonomyName": "Hospitalist Physician",
          "LicenseNumber": "26632",
          "LicenseNumberStateCode": "OK",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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