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1639271513 NPI number — DWIGHT O'DELL, M.D., LTD.

NPI Number: 1639271513
Health Care Provider/Practitioner: DWIGHT O'DELL, M.D., LTD.

Information about “1639271513” NPI (DWIGHT O'DELL, M.D., LTD.) exists in 1639271513 in HTML format HTML  |  1639271513 in plain Text format TXT  |  1639271513 in PDF (Portable Document Format) PDF  |  1639271513 in an XML format XML  formats.

NPI Number : 1639271513 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639271513",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DWIGHT O'DELL, M.D., LTD.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4550 MEMORIAL DR",
    "SecondLineMailingAddress": "SUITE 200",
    "MailingAddressCityName": "BELLEVILLE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "62226-5359",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-233-5998",
    "MailingAddressFaxNumber": "618-233-6001",
    "FirstLinePracticeLocationAddress": "4550 MEMORIAL DR",
    "SecondLinePracticeLocationAddress": "SUITE 200",
    "PracticeLocationAddressCityName": "BELLEVILLE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "62226-5359",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-233-5998",
    "PracticeLocationAddressFaxNumber": "618-233-6001",
    "EnumerationDate": "09/02/2006",
    "LastUpdateDate": "10/09/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "O'DELL",
    "AuthorizedOfficialFirstName": "DWIGHT",
    "AuthorizedOfficialMiddleName": "WILLIAM",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "618-233-5998",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207VG0400X",
        "TaxonomyName": "Gynecology Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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