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1528102183 NPI number — R DOUGLAS EDWARDS JR. DMD

NPI Number: 1528102183
Health Care Provider/Practitioner: R DOUGLAS EDWARDS JR. DMD

Information about “1528102183” NPI (R DOUGLAS EDWARDS JR. DMD) exists in 1528102183 in HTML format HTML  |  1528102183 in plain Text format TXT  |  1528102183 in PDF (Portable Document Format) PDF  |  1528102183 in an XML format XML  formats.

NPI Number : 1528102183 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1528102183",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EDWARDS",
    "FirstName": "R",
    "MiddleName": "DOUGLAS",
    "NamePrefix": "DR.",
    "NameSuffix": "JR.",
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "EDWARDS",
    "OtherFirstName": "ROBERT",
    "OtherMiddleName": "DOUGLAS",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": "JR.",
    "OtherCredential": "DMD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "3807 FREEDOM WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOUISVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40229",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "502-969-3205",
    "MailingAddressFaxNumber": "520-969-8306",
    "FirstLinePracticeLocationAddress": "3807 FREEDOM WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOUISVILLE",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "40229",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "502-969-3205",
    "PracticeLocationAddressFaxNumber": "520-969-8306",
    "EnumerationDate": "02/16/2007",
    "LastUpdateDate": "04/09/2015",
    "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": "4050",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "4050",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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