{
"Npi": {
"NPI": "1407880420",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "RICHARD N EVANS JR MD",
"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": "4555 W SCHROEDER DR",
"SecondLineMailingAddress": "SUITE 170",
"MailingAddressCityName": "MILWAUKEE",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53223-1475",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "414-365-3210",
"MailingAddressFaxNumber": "414-365-3225",
"FirstLinePracticeLocationAddress": "2266 N PROSPECT AVE",
"SecondLinePracticeLocationAddress": "SUITE 518",
"PracticeLocationAddressCityName": "MILWAUKEE",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53202-6319",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "414-277-7733",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/10/2006",
"LastUpdateDate": "05/21/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EVANS",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "N",
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "414-277-7733",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}