{
"Npi": {
"NPI": "1619981636",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WEBER",
"FirstName": "ROBERT",
"MiddleName": "BERNARD",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WEBER",
"OtherFirstName": "ROBERT",
"OtherMiddleName": "BERNARD",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "PO BOX 17763",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEVERLY HILLS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90209-3763",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-558-9777",
"MailingAddressFaxNumber": "310-558-9778",
"FirstLinePracticeLocationAddress": "12099 W WASHINGTON BLVD STE 300",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90066-2621",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-558-9777",
"PracticeLocationAddressFaxNumber": "310-558-9778",
"EnumerationDate": "07/27/2006",
"LastUpdateDate": "08/12/2020",
"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": "207RC0000X",
"TaxonomyName": "Cardiovascular Disease Physician",
"LicenseNumber": "G30439",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}