NPI Code Detail JSON Logo

1831651181 NPI number — SHANE DOUGLAS REYNAL

NPI Number: 1831651181
Health Care Provider/Practitioner: SHANE DOUGLAS REYNAL

Information about “1831651181” NPI (SHANE DOUGLAS REYNAL) exists in 1831651181 in HTML format HTML  |  1831651181 in plain Text format TXT  |  1831651181 in PDF (Portable Document Format) PDF  |  1831651181 in an XML format XML  formats.

NPI Number : 1831651181 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1831651181",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "REYNAL",
    "FirstName": "SHANE",
    "MiddleName": "DOUGLAS",
    "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": "7832 PAT BOOKER RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LIVE OAK",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78233-2601",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "210-657-9338",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7832 PAT BOOKER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LIVE OAK",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78233-2601",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "210-657-9338",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/04/2019",
    "LastUpdateDate": "08/21/2023",
    "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": "207N00000X",
        "TaxonomyName": "Dermatology Physician",
        "LicenseNumber": "U2302",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.