1780674838 NPI number — THEODORE W YAREMO M.D., P.A.

NPI Number: 1780674838
Health Care Provider/Practitioner: THEODORE W YAREMO M.D., P.A.

NPI Number : 1780674838 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1780674838",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "YAREMO",
    "FirstName": "THEODORE",
    "MiddleName": "W",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D., P.A.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "YAREMO",
    "OtherFirstName": "THEODORE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.D., PA",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "PO BOX 510550",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PUNTA GORDA",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33951-0550",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "941-637-6380",
    "MailingAddressFaxNumber": "941-347-8244",
    "FirstLinePracticeLocationAddress": "150 W MCKENZIE ST STE 117",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PUNTA GORDA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33950-5500",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "941-637-6062",
    "PracticeLocationAddressFaxNumber": "941-575-4449",
    "EnumerationDate": "10/28/2005",
    "LastUpdateDate": "04/26/2013",
    "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": "207RG0100X",
        "TaxonomyName": "Gastroenterology Physician",
        "LicenseNumber": "ME49299",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}