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1578764387 NPI number — JONATHAN ROBERT WALL

NPI Number: 1578764387
Health Care Provider/Practitioner: JONATHAN ROBERT WALL

Information about “1578764387” NPI (JONATHAN ROBERT WALL) exists in 1578764387 in HTML format HTML  |  1578764387 in plain Text format TXT  |  1578764387 in PDF (Portable Document Format) PDF  |  1578764387 in an XML format XML  formats.

NPI Number : 1578764387 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578764387",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALL",
    "FirstName": "JONATHAN",
    "MiddleName": "ROBERT",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WALL",
    "OtherFirstName": "JON",
    "OtherMiddleName": "ROBERT",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LMP",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "2940 S FRONTENAC ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SEATTLE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98108-3790",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "206-723-1381",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12811 SE 38TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BELLEVUE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98006-1326",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "425-378-1800",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/30/2007",
    "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": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": "MA00015057",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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