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1679837108 NPI number — PETER AWAD DPM

NPI Number: 1679837108
Health Care Provider/Practitioner: PETER AWAD DPM

Information about “1679837108” NPI (PETER AWAD DPM) exists in 1679837108 in HTML format HTML  |  1679837108 in plain Text format TXT  |  1679837108 in PDF (Portable Document Format) PDF  |  1679837108 in an XML format XML  formats.

NPI Number : 1679837108 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679837108",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AWAD",
    "FirstName": "PETER",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DPM",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "14047 TICONDEROGA CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FONTANA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92336-3553",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "848-228-9745",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "18151 BEAR VALLEY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HESPERIA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92345-4907",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-948-7400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/29/2012",
    "LastUpdateDate": "02/19/2020",
    "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": "213ES0103X",
          "TaxonomyName": "Foot & Ankle Surgery Podiatrist",
          "LicenseNumber": "E5168",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "213E00000X",
          "TaxonomyName": "Podiatrist",
          "LicenseNumber": "E5168",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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