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1821049867 NPI number — 4MD2 IN PATIENT PHYSICIAN SERVICES OF FORT WALTON BEACH LLC

NPI Number: 1821049867
Health Care Provider/Practitioner: 4MD2 IN PATIENT PHYSICIAN SERVICES OF FORT WALTON BEACH LLC

Information about “1821049867” NPI (4MD2 IN PATIENT PHYSICIAN SERVICES OF FORT WALTON BEACH LLC) exists in 1821049867 in HTML format HTML  |  1821049867 in plain Text format TXT  |  1821049867 in PDF (Portable Document Format) PDF  |  1821049867 in an XML format XML  formats.

NPI Number : 1821049867 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821049867",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "4MD2 IN PATIENT PHYSICIAN SERVICES OF FORT WALTON BEACH LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "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": "PO BOX 88477",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60680-1477",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "205-437-6098",
    "MailingAddressFaxNumber": "205-437-5998",
    "FirstLinePracticeLocationAddress": "1000 MAR WALT DR",
    "SecondLinePracticeLocationAddress": "SUITE 266",
    "PracticeLocationAddressCityName": "FORT WALTON BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32547-6708",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-863-7607",
    "PracticeLocationAddressFaxNumber": "205-437-5998",
    "EnumerationDate": "05/15/2006",
    "LastUpdateDate": "07/20/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "HOOPER",
    "AuthorizedOfficialFirstName": "GUY",
    "AuthorizedOfficialMiddleName": "DUWANE",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "205-437-6098",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208M00000X",
        "TaxonomyName": "Hospitalist Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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