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1962739839 NPI number — W JACKSON ILIFF M.D., LLC

NPI Number: 1962739839
Health Care Provider/Practitioner: W JACKSON ILIFF M.D., LLC

Information about “1962739839” NPI (W JACKSON ILIFF M.D., LLC) exists in 1962739839 in HTML format HTML  |  1962739839 in plain Text format TXT  |  1962739839 in PDF (Portable Document Format) PDF  |  1962739839 in an XML format XML  formats.

NPI Number : 1962739839 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962739839",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "W JACKSON ILIFF M.D., LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4 W ROLLING CROSSROADS",
    "SecondLineMailingAddress": "STE 7",
    "MailingAddressCityName": "CATONSVILLE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21228-6280",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-869-1990",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4 W ROLLING CROSSROADS",
    "SecondLinePracticeLocationAddress": "STE 7",
    "PracticeLocationAddressCityName": "CATONSVILLE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21228-6280",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-869-1990",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/12/2009",
    "LastUpdateDate": "11/12/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ILIFF",
    "AuthorizedOfficialFirstName": "W",
    "AuthorizedOfficialMiddleName": "JACKSON",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "410-869-1990",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207W00000X",
        "TaxonomyName": "Ophthalmology Physician",
        "LicenseNumber": "D08485",
        "LicenseNumberStateCode": "MD",
        "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."
      }
    }
  }
}
                
            

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