NPI Code Detail JSON Logo

1588681274 NPI number — LUCAS KIDD GWYNN MD

NPI Number: 1588681274
Health Care Provider/Practitioner: LUCAS KIDD GWYNN MD

Information about “1588681274” NPI (LUCAS KIDD GWYNN MD) exists in 1588681274 in HTML format HTML  |  1588681274 in plain Text format TXT  |  1588681274 in PDF (Portable Document Format) PDF  |  1588681274 in an XML format XML  formats.

NPI Number : 1588681274 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588681274",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GWYNN",
    "FirstName": "LUCAS",
    "MiddleName": "KIDD",
    "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": "6408 SEVEN CORNERS PL",
    "SecondLineMailingAddress": "SUITE J",
    "MailingAddressCityName": "FALLS CHURCH",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22044-2011",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "703-531-1030",
    "MailingAddressFaxNumber": "703-531-1031",
    "FirstLinePracticeLocationAddress": "6408 SEVEN CORNERS PL",
    "SecondLinePracticeLocationAddress": "SUITE J",
    "PracticeLocationAddressCityName": "FALLS CHURCH",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22044-2034",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-531-1030",
    "PracticeLocationAddressFaxNumber": "703-531-1031",
    "EnumerationDate": "07/17/2006",
    "LastUpdateDate": "09/11/2025",
    "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": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "0101223967",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "0101223967",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.