{
"Npi": {
"NPI": "1871907105",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WHITE",
"FirstName": "STEPHEN",
"MiddleName": "E.",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "P.A.-C.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1975 SHERINGTON PL APT H112",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEWPORT BEACH",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92663-6090",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "401-523-3545",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "22 CORPORATE PLAZA DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEWPORT BEACH",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92660",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-722-5017",
"PracticeLocationAddressFaxNumber": "949-432-3354",
"EnumerationDate": "06/14/2014",
"LastUpdateDate": "02/17/2020",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "0110004697",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA031038",
"LicenseNumberStateCode": "DC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "C0005385",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": "C05385",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "53342",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}