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1568617108 NPI number — RYAN B VIETS MD

NPI Number: 1568617108
Health Care Provider/Practitioner: RYAN B VIETS MD

Information about “1568617108” NPI (RYAN B VIETS MD) exists in 1568617108 in HTML format HTML  |  1568617108 in plain Text format TXT  |  1568617108 in PDF (Portable Document Format) PDF  |  1568617108 in an XML format XML  formats.

NPI Number : 1568617108 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568617108",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VIETS",
    "FirstName": "RYAN",
    "MiddleName": "B",
    "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": "7777 ALVARADO ROAD # 108",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LA MESA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91942",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "619-460-2770",
    "MailingAddressFaxNumber": "619-460-2774",
    "FirstLinePracticeLocationAddress": "5555 GROSSMONT CENTER DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LA MESA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91942",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "619-740-4034",
    "PracticeLocationAddressFaxNumber": "619-740-4324",
    "EnumerationDate": "11/24/2008",
    "LastUpdateDate": "10/02/2020",
    "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": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "A125809",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "2012012483",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "A151144",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2085N0700X",
          "TaxonomyName": "Neuroradiology Physician",
          "LicenseNumber": "A151144",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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