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1518103340 NPI number — JEFFORY LYNN BROMAN DDS

NPI Number: 1518103340
Health Care Provider/Practitioner: JEFFORY LYNN BROMAN DDS

Information about “1518103340” NPI (JEFFORY LYNN BROMAN DDS) exists in 1518103340 in HTML format HTML  |  1518103340 in plain Text format TXT  |  1518103340 in PDF (Portable Document Format) PDF  |  1518103340 in an XML format XML  formats.

NPI Number : 1518103340 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1518103340",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROMAN",
    "FirstName": "JEFFORY",
    "MiddleName": "LYNN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "215 SOUTH 10TH EAST",
    "SecondLineMailingAddress": "SUITE A",
    "MailingAddressCityName": "SALT LAKE CITY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84102",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-328-4173",
    "MailingAddressFaxNumber": "801-322-3995",
    "FirstLinePracticeLocationAddress": "215 SOUTH 10TH EAST",
    "SecondLinePracticeLocationAddress": "SUITE A",
    "PracticeLocationAddressCityName": "SALT LAKE CITY",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84102",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-328-4173",
    "PracticeLocationAddressFaxNumber": "801-322-3995",
    "EnumerationDate": "12/29/2008",
    "LastUpdateDate": "12/29/2008",
    "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": "122300000X",
        "TaxonomyName": "Dentist",
        "LicenseNumber": "1410689922",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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