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1659141968 NPI number — JESSE STAYTON BROCK A.P. DOM

NPI Number: 1659141968
Health Care Provider/Practitioner: JESSE STAYTON BROCK A.P. DOM

Information about “1659141968” NPI (JESSE STAYTON BROCK A.P. DOM) exists in 1659141968 in HTML format HTML  |  1659141968 in plain Text format TXT  |  1659141968 in PDF (Portable Document Format) PDF  |  1659141968 in an XML format XML  formats.

NPI Number : 1659141968 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659141968",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROCK",
    "FirstName": "JESSE",
    "MiddleName": "STAYTON",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "A.P. DOM",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11270 82ND ST E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PARRISH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34219-2705",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "941-504-2372",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "11270 82ND ST E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PARRISH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34219-2705",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "941-504-2372",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/08/2024",
    "LastUpdateDate": "01/08/2024",
    "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": "171100000X",
        "TaxonomyName": "Acupuncturist",
        "LicenseNumber": "AP4543",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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