{
"Npi": {
"NPI": "1437150752",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DORRANCE",
"FirstName": "KEVIN",
"MiddleName": "ARNOLD",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "25714 RIDGE ROAD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DAMASCUS",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20872-1852",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "240-731-8330",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7616 CULEBRA RD",
"SecondLinePracticeLocationAddress": "SUITE 130",
"PracticeLocationAddressCityName": "SAN ANTONIO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78251",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "726-201-3660",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/09/2005",
"LastUpdateDate": "11/05/2024",
"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": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "52862",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "V4104",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}