{
"Npi": {
"NPI": "1801933288",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KOZLOFF",
"FirstName": "MATTHEW",
"MiddleName": "S",
"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": "2067 WINERIDGE PLACE",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "ESCONDIDO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92029-1952",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-489-5955",
"MailingAddressFaxNumber": "760-489-7150",
"FirstLinePracticeLocationAddress": "838 NORDAHL ROAD",
"SecondLinePracticeLocationAddress": "SUITE 270",
"PracticeLocationAddressCityName": "SAN MARCOS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92069-3596",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-489-5955",
"PracticeLocationAddressFaxNumber": "760-489-7150",
"EnumerationDate": "02/01/2007",
"LastUpdateDate": "12/07/2017",
"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": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "C55616",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "ME108087",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "40482",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2086S0102X",
"TaxonomyName": "Surgical Critical Care Physician",
"LicenseNumber": "40482",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2086S0127X",
"TaxonomyName": "Trauma Surgery Physician",
"LicenseNumber": "MD12565",
"LicenseNumberStateCode": "RI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2086S0127X",
"TaxonomyName": "Trauma Surgery Physician",
"LicenseNumber": "40482",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}