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1417933698 NPI number — STEPHEN BROPHY BERRIEN M.D.

NPI Number: 1417933698
Health Care Provider/Practitioner: STEPHEN BROPHY BERRIEN M.D.

Information about “1417933698” NPI (STEPHEN BROPHY BERRIEN M.D.) exists in 1417933698 in HTML format HTML  |  1417933698 in plain Text format TXT  |  1417933698 in PDF (Portable Document Format) PDF  |  1417933698 in an XML format XML  formats.

NPI Number : 1417933698 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417933698",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BERRIEN",
    "FirstName": "STEPHEN",
    "MiddleName": "BROPHY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1524 MCHENRY AVE",
    "SecondLineMailingAddress": "SUITE 300",
    "MailingAddressCityName": "MODESTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95350-4500",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "209-527-0615",
    "MailingAddressFaxNumber": "209-527-5201",
    "FirstLinePracticeLocationAddress": "1524 MCHENRY AVE",
    "SecondLinePracticeLocationAddress": "SUITE 300",
    "PracticeLocationAddressCityName": "MODESTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95350-4500",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "209-527-0615",
    "PracticeLocationAddressFaxNumber": "209-527-5201",
    "EnumerationDate": "12/19/2005",
    "LastUpdateDate": "02/02/2011",
    "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": "207X00000X",
        "TaxonomyName": "Orthopaedic Surgery Physician",
        "LicenseNumber": "00C321460",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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