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1740376102 NPI number — JON E PERRY PA

NPI Number: 1740376102
Health Care Provider/Practitioner: JON E PERRY PA

Information about “1740376102” NPI (JON E PERRY PA) exists in 1740376102 in HTML format HTML  |  1740376102 in plain Text format TXT  |  1740376102 in PDF (Portable Document Format) PDF  |  1740376102 in an XML format XML  formats.

NPI Number : 1740376102 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740376102",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PERRY",
    "FirstName": "JON",
    "MiddleName": "E",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "714 GARDEN PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROSWELL",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "88201-7767",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "575-489-4750",
    "MailingAddressFaxNumber": "575-586-4414",
    "FirstLinePracticeLocationAddress": "1700 N UNION AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROSWELL",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "88201-3267",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "575-489-4750",
    "PracticeLocationAddressFaxNumber": "575-586-4414",
    "EnumerationDate": "10/05/2006",
    "LastUpdateDate": "01/02/2020",
    "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": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA22153",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "085-002088",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "PA-848",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA2011-0062",
          "LicenseNumberStateCode": "NM",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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