{
"Npi": {
"NPI": "1881747046",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DREW",
"FirstName": "DANNY",
"MiddleName": "ELLIOTT",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DREW",
"OtherFirstName": "DANIEL",
"OtherMiddleName": "ELLIOTT",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "614 E EMMA AVE STE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRINGDALE",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72764-4469",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-751-7417",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "614 E EMMA AVE STE 300",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRINGDALE",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72764-4469",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "479-751-7417",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/19/2007",
"LastUpdateDate": "03/19/2025",
"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": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "A98440",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "MD152952",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "E-18570",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}