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1750511168 NPI number — NATHAN T STILLWAGON M.D.

NPI Number: 1750511168
Health Care Provider/Practitioner: NATHAN T STILLWAGON M.D.

Information about “1750511168” NPI (NATHAN T STILLWAGON M.D.) exists in 1750511168 in HTML format HTML  |  1750511168 in plain Text format TXT  |  1750511168 in PDF (Portable Document Format) PDF  |  1750511168 in an XML format XML  formats.

NPI Number : 1750511168 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750511168",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "STILLWAGON",
    "FirstName": "NATHAN",
    "MiddleName": "T",
    "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": "2963 E COPPER POINT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MERIDIAN",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83642-9055",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "608-890-8682",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2963 E COPPER POINT DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MERIDIAN",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83642-9055",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-322-1730",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/20/2009",
    "LastUpdateDate": "09/25/2017",
    "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": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "MD184107",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207P00000X",
          "TaxonomyName": "Emergency Medicine Physician",
          "LicenseNumber": "M-11728",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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