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1881810455 NPI number — BYRON JAMES RUSSELL LAC

NPI Number: 1881810455
Health Care Provider/Practitioner: BYRON JAMES RUSSELL LAC

Information about “1881810455” NPI (BYRON JAMES RUSSELL LAC) exists in 1881810455 in HTML format HTML  |  1881810455 in plain Text format TXT  |  1881810455 in PDF (Portable Document Format) PDF  |  1881810455 in an XML format XML  formats.

NPI Number : 1881810455 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1881810455",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUSSELL",
    "FirstName": "BYRON",
    "MiddleName": "JAMES",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "LAC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1728 LIBERTY ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EL CERRITO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94530-1913",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "415-902-4070",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2211 POST ST STE 204",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN FRANCISCO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94115-3467",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "415-902-4070",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/18/2007",
    "LastUpdateDate": "10/30/2008",
    "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": "171100000X",
        "TaxonomyName": "Acupuncturist",
        "LicenseNumber": "AC7130",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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