{
"Npi": {
"NPI": "1407343551",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FAMUYIRO",
"FirstName": "TOLULOPE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "AKINTIDE",
"OtherFirstName": "TOLULOPE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "6101 BLUE LAGOON DR STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33126-3168",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "844-630-0700",
"MailingAddressFaxNumber": "877-374-1924",
"FirstLinePracticeLocationAddress": "6404 GROOM RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BAKER",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70714-4364",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "225-614-9065",
"PracticeLocationAddressFaxNumber": "855-583-3594",
"EnumerationDate": "04/14/2018",
"LastUpdateDate": "03/20/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207QG0300X",
"TaxonomyName": "Geriatric Medicine (Family Medicine) Physician",
"LicenseNumber": "0101271156",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207QG0300X",
"TaxonomyName": "Geriatric Medicine (Family Medicine) Physician",
"LicenseNumber": "288037",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}