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1417286121 NPI number — SIMON J. MCCOY D.P.M

NPI Number: 1417286121
Health Care Provider/Practitioner: SIMON J. MCCOY D.P.M

Information about “1417286121” NPI (SIMON J. MCCOY D.P.M) exists in 1417286121 in HTML format HTML  |  1417286121 in plain Text format TXT  |  1417286121 in PDF (Portable Document Format) PDF  |  1417286121 in an XML format XML  formats.

NPI Number : 1417286121 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417286121",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCOY",
    "FirstName": "SIMON",
    "MiddleName": "J.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.P.M",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCCOY",
    "OtherFirstName": "S.",
    "OtherMiddleName": "JAMES",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "D.P.M.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "PO BOX 282",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HARBOR BEACH",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48441-0282",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "810-535-5507",
    "MailingAddressFaxNumber": "810-535-5578",
    "FirstLinePracticeLocationAddress": "219 STATE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HARBOR BEACH",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48441-1206",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "810-535-5507",
    "PracticeLocationAddressFaxNumber": "810-535-5578",
    "EnumerationDate": "12/09/2009",
    "LastUpdateDate": "02/14/2024",
    "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": "213ES0103X",
          "TaxonomyName": "Foot & Ankle Surgery Podiatrist",
          "LicenseNumber": "5901002343",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "213E00000X",
          "TaxonomyName": "Podiatrist",
          "LicenseNumber": "5901002343",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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