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1437904919 NPI number — TANNER LEE VINCENT

NPI Number: 1437904919
Health Care Provider/Practitioner: TANNER LEE VINCENT

Information about “1437904919” NPI (TANNER LEE VINCENT) exists in 1437904919 in HTML format HTML  |  1437904919 in plain Text format TXT  |  1437904919 in PDF (Portable Document Format) PDF  |  1437904919 in an XML format XML  formats.

NPI Number : 1437904919 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437904919",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VINCENT",
    "FirstName": "TANNER",
    "MiddleName": "LEE",
    "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": "2001 W 86TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDIANAPOLIS",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46260-1902",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "317-338-6399",
    "MailingAddressFaxNumber": "317-338-6359",
    "FirstLinePracticeLocationAddress": "3200 COLD SPRING RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIANAPOLIS",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46222-1960",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "317-955-6000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/18/2024",
    "LastUpdateDate": "04/10/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "03/25/2025",
    "NPIReactivationDate": "04/10/2025",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "390200000X",
        "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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