NPI Code Detail JSON Logo

1710988936 NPI number — EDWARD J SHERIDAN M.D.

NPI Number: 1710988936
Health Care Provider/Practitioner: EDWARD J SHERIDAN M.D.

Information about “1710988936” NPI (EDWARD J SHERIDAN M.D.) exists in 1710988936 in HTML format HTML  |  1710988936 in plain Text format TXT  |  1710988936 in PDF (Portable Document Format) PDF  |  1710988936 in an XML format XML  formats.

NPI Number : 1710988936 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710988936",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHERIDAN",
    "FirstName": "EDWARD",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1456 JACKSON PIKE",
    "SecondLineMailingAddress": "STE 2",
    "MailingAddressCityName": "GALLIPOLIS",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45631-2602",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "740-446-0112",
    "MailingAddressFaxNumber": "740-446-4732",
    "FirstLinePracticeLocationAddress": "159 E 2ND ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHILLICOTHEE",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45601-2526",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "740-773-6347",
    "PracticeLocationAddressFaxNumber": "740-773-9093",
    "EnumerationDate": "08/10/2005",
    "LastUpdateDate": "07/15/2009",
    "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": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "35038030S",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "11622",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "4301060933",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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