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1588689541 NPI number — DIANA A. PRABLEK MD

NPI Number: 1588689541
Health Care Provider/Practitioner: DIANA A. PRABLEK MD

Information about “1588689541” NPI (DIANA A. PRABLEK MD) exists in 1588689541 in HTML format HTML  |  1588689541 in plain Text format TXT  |  1588689541 in PDF (Portable Document Format) PDF  |  1588689541 in an XML format XML  formats.

NPI Number : 1588689541 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588689541",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PRABLEK",
    "FirstName": "DIANA",
    "MiddleName": "A.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MEDEROS",
    "OtherFirstName": "DIANA",
    "OtherMiddleName": "ALICIA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "850 DEAVER LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63141-7732",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-941-4896",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4055 VALLEY VIEW LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75244-5074",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "469-466-7420",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/12/2006",
    "LastUpdateDate": "11/02/2021",
    "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": "207RI0200X",
          "TaxonomyName": "Infectious Disease Physician",
          "LicenseNumber": "109302",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "109302",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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