{
"Npi": {
"NPI": "1710214820",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MACKINNON",
"FirstName": "ALEXANDER",
"MiddleName": "C",
"NamePrefix": "DR.",
"NameSuffix": "JR.",
"Credential": "M.D., PH.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 55310",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BIRMINGHAM",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "35255-5310",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "205-731-9701",
"MailingAddressFaxNumber": "205-297-9411",
"FirstLinePracticeLocationAddress": "619 19TH ST S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BIRMINGHAM",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "35249-3522",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "205-934-4011",
"PracticeLocationAddressFaxNumber": "205-297-9411",
"EnumerationDate": "11/10/2009",
"LastUpdateDate": "09/24/2019",
"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": "207ZP0007X",
"TaxonomyName": "Molecular Genetic Pathology (Pathology) Physician",
"LicenseNumber": "54826",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207ZP0007X",
"TaxonomyName": "Molecular Genetic Pathology (Pathology) Physician",
"LicenseNumber": "036.118124",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207ZP0101X",
"TaxonomyName": "Anatomic Pathology Physician",
"LicenseNumber": "54826",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207ZP0101X",
"TaxonomyName": "Anatomic Pathology Physician",
"LicenseNumber": "036.118124",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207ZP0101X",
"TaxonomyName": "Anatomic Pathology Physician",
"LicenseNumber": "38623",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}