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1629709159 NPI number — KALEB JORDAN MURRAY DDS

NPI Number: 1629709159
Health Care Provider/Practitioner: KALEB JORDAN MURRAY DDS

Information about “1629709159” NPI (KALEB JORDAN MURRAY DDS) exists in 1629709159 in HTML format HTML  |  1629709159 in plain Text format TXT  |  1629709159 in PDF (Portable Document Format) PDF  |  1629709159 in an XML format XML  formats.

NPI Number : 1629709159 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629709159",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MURRAY",
    "FirstName": "KALEB",
    "MiddleName": "JORDAN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "116 BRENTWOOD BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAFAYETTE",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "70503-3830",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "504-615-1264",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "114 DEREK PLAZA DR STE E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CARENCRO",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "70520-3644",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "337-516-2233",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/24/2022",
    "LastUpdateDate": "07/31/2025",
    "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": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "D-0007043-C1",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "7325",
          "LicenseNumberStateCode": "LA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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