{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "REX E. MOULTON-BARRETT, M.D., INC.",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2070 CLINTON AVE",
"SecondLineMailingAddress": "FOURTH FLOOR",
"MailingAddressCityName": "ALAMEDA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94501-4320",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-864-1800",
"MailingAddressFaxNumber": "510-864-1180",
"FirstLinePracticeLocationAddress": "2070 CLINTON AVE",
"SecondLinePracticeLocationAddress": "FOURTH FLOOR",
"PracticeLocationAddressCityName": "ALAMEDA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94501-4320",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "510-864-1800",
"PracticeLocationAddressFaxNumber": "510-864-1180",
"EnumerationDate": "08/31/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOULTON-BARRETT",
"AuthorizedOfficialFirstName": "REX",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "510-864-1800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "A45787",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}