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1891705026 NPI number — ERICK A BUITRAGO M.S.ED., LAT, ATC

NPI Number: 1891705026
Health Care Provider/Practitioner: ERICK A BUITRAGO M.S.ED., LAT, ATC

Information about “1891705026” NPI (ERICK A BUITRAGO M.S.ED., LAT, ATC) exists in 1891705026 in HTML format HTML  |  1891705026 in plain Text format TXT  |  1891705026 in PDF (Portable Document Format) PDF  |  1891705026 in an XML format XML  formats.

NPI Number : 1891705026 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1891705026",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BUITRAGO",
    "FirstName": "ERICK",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S.ED., LAT, ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7979 SWEETWATER CT",
    "SecondLineMailingAddress": "APT. N",
    "MailingAddressCityName": "TERRE HAUTE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47802-9503",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "812-237-4066",
    "MailingAddressFaxNumber": "812-237-9612",
    "FirstLinePracticeLocationAddress": "ATHLETIC TRAINING DEPARTMENT",
    "SecondLinePracticeLocationAddress": "ARENA RM B-17",
    "PracticeLocationAddressCityName": "TERRE HAUTE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47809-0001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-237-4066",
    "PracticeLocationAddressFaxNumber": "812-237-9612",
    "EnumerationDate": "08/09/2006",
    "LastUpdateDate": "07/08/2007",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "36001258A",
        "LicenseNumberStateCode": "IN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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