NPI Code Detail JSON Logo

1457856502 NPI number — WILLIAM JAMES PREDUN MD

NPI Number: 1457856502
Health Care Provider/Practitioner: WILLIAM JAMES PREDUN MD

Information about “1457856502” NPI (WILLIAM JAMES PREDUN MD) exists in 1457856502 in HTML format HTML  |  1457856502 in plain Text format TXT  |  1457856502 in PDF (Portable Document Format) PDF  |  1457856502 in an XML format XML  formats.

NPI Number : 1457856502 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457856502",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PREDUN",
    "FirstName": "WILLIAM",
    "MiddleName": "JAMES",
    "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": "9825 JORDAN GATEWAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SANDY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84070",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "744 S WEBSTER AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREEN BAY",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54301-3505",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "917-593-8973",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/29/2018",
    "LastUpdateDate": "08/31/2021",
    "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": "75630-20",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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