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1689628216 NPI number — LEONARD R LARUSSA DPM

NPI Number: 1689628216
Health Care Provider/Practitioner: LEONARD R LARUSSA DPM

Information about “1689628216” NPI (LEONARD R LARUSSA DPM) exists in 1689628216 in HTML format HTML  |  1689628216 in plain Text format TXT  |  1689628216 in PDF (Portable Document Format) PDF  |  1689628216 in an XML format XML  formats.

NPI Number : 1689628216 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689628216",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LARUSSA",
    "FirstName": "LEONARD",
    "MiddleName": "R",
    "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": "201A REES ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AMERICUS",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31709-3752",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "229-931-0505",
    "MailingAddressFaxNumber": "229-931-0509",
    "FirstLinePracticeLocationAddress": "201A REESE STREET",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AMERICUS",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31709-3752",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "229-931-0505",
    "PracticeLocationAddressFaxNumber": "229-931-0509",
    "EnumerationDate": "05/19/2006",
    "LastUpdateDate": "02/12/2022",
    "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": "POD000775",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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