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1770504250 NPI number — PHILIP C TROTTA M.D.

NPI Number: 1770504250
Health Care Provider/Practitioner: PHILIP C TROTTA M.D.

Information about “1770504250” NPI (PHILIP C TROTTA M.D.) exists in 1770504250 in HTML format HTML  |  1770504250 in plain Text format TXT  |  1770504250 in PDF (Portable Document Format) PDF  |  1770504250 in an XML format XML  formats.

NPI Number : 1770504250 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770504250",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TROTTA",
    "FirstName": "PHILIP",
    "MiddleName": "C",
    "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": "PO BOX 411515",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63141-3515",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-333-6750",
    "MailingAddressFaxNumber": "314-432-0178",
    "FirstLinePracticeLocationAddress": "13303 TESSON FERRY RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63128-4062",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-843-5888",
    "PracticeLocationAddressFaxNumber": "314-843-1905",
    "EnumerationDate": "07/21/2006",
    "LastUpdateDate": "10/18/2011",
    "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": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "32168",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "036053242",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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