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1467837377 NPI number — DEACON EMMET FARRELL M.D

NPI Number: 1467837377
Health Care Provider/Practitioner: DEACON EMMET FARRELL M.D

Information about “1467837377” NPI (DEACON EMMET FARRELL M.D) exists in 1467837377 in HTML format HTML  |  1467837377 in plain Text format TXT  |  1467837377 in PDF (Portable Document Format) PDF  |  1467837377 in an XML format XML  formats.

NPI Number : 1467837377 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467837377",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FARRELL",
    "FirstName": "DEACON",
    "MiddleName": "EMMET",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8010 HOLLYWOOD BLVD",
    "SecondLineMailingAddress": "DECON - SUTIE- APT 609",
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90046",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "347-379-0135",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8700 BEVERLY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST HOLLYWOOD",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90048-1804",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "310-423-1000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/22/2015",
    "LastUpdateDate": "09/30/2024",
    "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": "207LP2900X",
          "TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
          "LicenseNumber": "A163151",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "A163151",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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