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1578673067 NPI number — AMY C KORB P.A.

NPI Number: 1578673067
Health Care Provider/Practitioner: AMY C KORB P.A.

Information about “1578673067” NPI (AMY C KORB P.A.) exists in 1578673067 in HTML format HTML  |  1578673067 in plain Text format TXT  |  1578673067 in PDF (Portable Document Format) PDF  |  1578673067 in an XML format XML  formats.

NPI Number : 1578673067 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578673067",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KORB",
    "FirstName": "AMY",
    "MiddleName": "C",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "P.A.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1860 IRIS ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKEWOOD",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80215",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "720-299-4919",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1411 S POTOMAC ST",
    "SecondLinePracticeLocationAddress": "STE 400",
    "PracticeLocationAddressCityName": "AURORA",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80012-4536",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "303-695-6060",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/30/2006",
    "LastUpdateDate": "12/30/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "010446",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA05052",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "PA-2933",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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