NPI Code Detail JSON Logo

1669685301 NPI number — MARK P LOGUE CPO

NPI Number: 1669685301
Health Care Provider/Practitioner: MARK P LOGUE CPO

Information about “1669685301” NPI (MARK P LOGUE CPO) exists in 1669685301 in HTML format HTML  |  1669685301 in plain Text format TXT  |  1669685301 in PDF (Portable Document Format) PDF  |  1669685301 in an XML format XML  formats.

NPI Number : 1669685301 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669685301",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LOGUE",
    "FirstName": "MARK",
    "MiddleName": "P",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "CPO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2214 DONATO DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BELLEAIR BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33786-3433",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "727-449-9292",
    "MailingAddressFaxNumber": "727-449-9393",
    "FirstLinePracticeLocationAddress": "516 LAKEVIEW RD",
    "SecondLinePracticeLocationAddress": "VILLA 1",
    "PracticeLocationAddressCityName": "CLEARWATER",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33756-3302",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "727-449-9292",
    "PracticeLocationAddressFaxNumber": "727-449-9393",
    "EnumerationDate": "05/08/2007",
    "LastUpdateDate": "01/09/2008",
    "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": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": "POR161",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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