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1841458619 NPI number — SAIRA BANOO MOMIN DO

NPI Number: 1841458619
Health Care Provider/Practitioner: SAIRA BANOO MOMIN DO

Information about “1841458619” NPI (SAIRA BANOO MOMIN DO) exists in 1841458619 in HTML format HTML  |  1841458619 in plain Text format TXT  |  1841458619 in PDF (Portable Document Format) PDF  |  1841458619 in an XML format XML  formats.

NPI Number : 1841458619 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841458619",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOMIN",
    "FirstName": "SAIRA",
    "MiddleName": "BANOO",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2020 W STATE HIGHWAY 114 STE 340",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GRAPEVINE",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76051-8650",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-410-7700",
    "MailingAddressFaxNumber": "817-410-7720",
    "FirstLinePracticeLocationAddress": "2020 W STATE HIGHWAY 114 STE 340",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GRAPEVINE",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76051-8650",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-410-7700",
    "PracticeLocationAddressFaxNumber": "817-410-7720",
    "EnumerationDate": "05/29/2008",
    "LastUpdateDate": "06/06/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207ND0101X",
          "TaxonomyName": "MOHS-Micrographic Surgery Physician",
          "LicenseNumber": "P1000",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "SL0521",
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207ND0101X",
          "TaxonomyName": "MOHS-Micrographic Surgery Physician",
          "LicenseNumber": "OS11005",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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