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1598177891 NPI number — DUSTIN DOMINIC GOETZ M.D.

NPI Number: 1598177891
Health Care Provider/Practitioner: DUSTIN DOMINIC GOETZ M.D.

Information about “1598177891” NPI (DUSTIN DOMINIC GOETZ M.D.) exists in 1598177891 in HTML format HTML  |  1598177891 in plain Text format TXT  |  1598177891 in PDF (Portable Document Format) PDF  |  1598177891 in an XML format XML  formats.

NPI Number : 1598177891 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598177891",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOETZ",
    "FirstName": "DUSTIN",
    "MiddleName": "DOMINIC",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "202 E GREENFIELD LN STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BISMARCK",
    "MailingAddressStateName": "ND",
    "MailingAddressPostalCode": "58503-6597",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "701-223-7822",
    "MailingAddressFaxNumber": "701-223-7844",
    "FirstLinePracticeLocationAddress": "202 E GREENFIELD LN STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BISMARCK",
    "PracticeLocationAddressStateName": "ND",
    "PracticeLocationAddressPostalCode": "58503-6597",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "701-223-7822",
    "PracticeLocationAddressFaxNumber": "701-223-7844",
    "EnumerationDate": "05/21/2014",
    "LastUpdateDate": "09/22/2021",
    "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": "207LP2900X",
          "TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
          "LicenseNumber": "PT15745",
          "LicenseNumberStateCode": "ND",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "15745",
          "LicenseNumberStateCode": "ND",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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