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1487861969 NPI number — BOBBY RAY SEAGO

NPI Number: 1487861969
Health Care Provider/Practitioner: BOBBY RAY SEAGO

Information about “1487861969” NPI (BOBBY RAY SEAGO) exists in 1487861969 in HTML format HTML  |  1487861969 in plain Text format TXT  |  1487861969 in PDF (Portable Document Format) PDF  |  1487861969 in an XML format XML  formats.

NPI Number : 1487861969 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487861969",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SEAGO",
    "FirstName": "BOBBY",
    "MiddleName": "RAY",
    "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": "1013 LAKE GROVE LOOP",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIDLOTHIAN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76065-5643",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "972-775-4674",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "100 WALTER STEPHENSON RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MIDLOTHIAN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76065-3418",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "972-775-8174",
    "PracticeLocationAddressFaxNumber": "972-775-5139",
    "EnumerationDate": "05/16/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "AT1703",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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