{
"Npi": {
"NPI": "1588248769",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "IBRAHIM YAZJI MD PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 150",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORTER",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77365-0150",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "281-899-0229",
"MailingAddressFaxNumber": "281-803-8381",
"FirstLinePracticeLocationAddress": "24044 HIGHWAY 59 N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KINGWOOD",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77339-1500",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "281-899-0229",
"PracticeLocationAddressFaxNumber": "281-803-8381",
"EnumerationDate": "05/12/2021",
"LastUpdateDate": "07/26/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "YAZJI",
"AuthorizedOfficialFirstName": "IBRAHIM",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "OWNER/MANAGER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "904-910-2307",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208G00000X",
"TaxonomyName": "Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}