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1750969416 NPI number — MICHAEL JOHN MADISON JUNIOR

NPI Number: 1750969416
Health Care Provider/Practitioner: MICHAEL JOHN MADISON JUNIOR

Information about “1750969416” NPI (MICHAEL JOHN MADISON JUNIOR) exists in 1750969416 in HTML format HTML  |  1750969416 in plain Text format TXT  |  1750969416 in PDF (Portable Document Format) PDF  |  1750969416 in an XML format XML  formats.

NPI Number : 1750969416 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750969416",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JUNIOR",
    "FirstName": "MICHAEL",
    "MiddleName": "JOHN MADISON",
    "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": "902 KALANCHOE CT APT A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLLEGE STATION",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77840-4136",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "469-834-4940",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3500 GASTON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75246-2088",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-820-2361",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/01/2021",
    "LastUpdateDate": "06/03/2025",
    "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": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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