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1457357006 NPI number — MARIUSZ JERZY KLIN MD, PHD

NPI Number: 1457357006
Health Care Provider/Practitioner: MARIUSZ JERZY KLIN MD, PHD

Information about “1457357006” NPI (MARIUSZ JERZY KLIN MD, PHD) exists in 1457357006 in HTML format HTML  |  1457357006 in plain Text format TXT  |  1457357006 in PDF (Portable Document Format) PDF  |  1457357006 in an XML format XML  formats.

NPI Number : 1457357006 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457357006",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KLIN",
    "FirstName": "MARIUSZ",
    "MiddleName": "JERZY",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD, PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 452",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LYNN HAVEN",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32444-0452",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "850-215-7071",
    "MailingAddressFaxNumber": "850-215-7073",
    "FirstLinePracticeLocationAddress": "2202 STATE AVE",
    "SecondLinePracticeLocationAddress": "SUITE 301",
    "PracticeLocationAddressCityName": "PANAMA CITY",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32405-7601",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-215-7071",
    "PracticeLocationAddressFaxNumber": "850-215-7073",
    "EnumerationDate": "06/27/2005",
    "LastUpdateDate": "05/16/2008",
    "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": "207RG0100X",
          "TaxonomyName": "Gastroenterology Physician",
          "LicenseNumber": "ME85851",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207RG0100X",
          "TaxonomyName": "Gastroenterology Physician",
          "LicenseNumber": "A63234",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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