{
"Npi": {
"NPI": "1376715409",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LARRY T. WONG, D.O., P.A.",
"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": "502 N MACARTHUR AVE",
"SecondLineMailingAddress": "SUITE C",
"MailingAddressCityName": "PANAMA CITY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32401-3654",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-215-1080",
"MailingAddressFaxNumber": "850-215-1086",
"FirstLinePracticeLocationAddress": "502 N MACARTHUR AVE",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "PANAMA CITY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32401-3654",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-215-1080",
"PracticeLocationAddressFaxNumber": "850-215-1086",
"EnumerationDate": "03/28/2008",
"LastUpdateDate": "10/15/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WONG",
"AuthorizedOfficialFirstName": "LARRY",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "850-215-1080",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "OS9154",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}