NPI Code Detail JSON Logo

1720388077 NPI number — MARVIN M FURDGE

NPI Number: 1720388077
Health Care Provider/Practitioner: MARVIN M FURDGE

Information about “1720388077” NPI (MARVIN M FURDGE) exists in 1720388077 in HTML format HTML  |  1720388077 in plain Text format TXT  |  1720388077 in PDF (Portable Document Format) PDF  |  1720388077 in an XML format XML  formats.

NPI Number : 1720388077 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720388077",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FURDGE",
    "FirstName": "MARVIN",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "604 PARTRIDGE DRIVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AUBREY",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76227",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "870-972-4939",
    "MailingAddressFaxNumber": "870-972-4911",
    "FirstLinePracticeLocationAddress": "604 PARTRIDGE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUBREY",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76227-3719",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "662-306-0732",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/02/2010",
    "LastUpdateDate": "10/17/2022",
    "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": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "73507",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "12724",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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