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1437192531 NPI number — DANA V WALLACE MD

NPI Number: 1437192531
Health Care Provider/Practitioner: DANA V WALLACE MD

Information about “1437192531” NPI (DANA V WALLACE MD) exists in 1437192531 in HTML format HTML  |  1437192531 in plain Text format TXT  |  1437192531 in PDF (Portable Document Format) PDF  |  1437192531 in an XML format XML  formats.

NPI Number : 1437192531 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437192531",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALLACE",
    "FirstName": "DANA",
    "MiddleName": "V",
    "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": "11880 SW 40TH ST",
    "SecondLineMailingAddress": "SUITE 304",
    "MailingAddressCityName": "MIAMI",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33175-3584",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "305-223-8808",
    "MailingAddressFaxNumber": "305-223-8974",
    "FirstLinePracticeLocationAddress": "2699 STIRLING RD STE B305",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FT LAUDERDALE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33312-6546",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-981-9180",
    "PracticeLocationAddressFaxNumber": "954-961-4752",
    "EnumerationDate": "06/14/2006",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207K00000X",
        "TaxonomyName": "Allergy & Immunology Physician",
        "LicenseNumber": "ME0025502",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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