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1407724362 NPI number — RODDRICK SIMILTON

NPI Number: 1407724362
Health Care Provider/Practitioner: RODDRICK SIMILTON

Information about “1407724362” NPI (RODDRICK SIMILTON) exists in 1407724362 in HTML format HTML  |  1407724362 in plain Text format TXT  |  1407724362 in PDF (Portable Document Format) PDF  |  1407724362 in an XML format XML  formats.

NPI Number : 1407724362 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407724362",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SIMILTON",
    "FirstName": "RODDRICK",
    "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": "3521 GOLDEN MEADOWS CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAYTON",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45404-1437",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "256-468-3188",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3521 GOLDEN MEADOWS CT",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAYTON",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45404-1437",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "256-468-3188",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/23/2025",
    "LastUpdateDate": "10/23/2025",
    "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": "175T00000X",
        "TaxonomyName": "Peer Specialist",
        "LicenseNumber": "APS.006883",
        "LicenseNumberStateCode": "OH",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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