NPI Code Detail JSON Logo

1972625721 NPI number — DR. RAFAEL O. MOLLEGA , JR. OF NORTHWEST FLORIDA, INC

NPI Number: 1972625721
Health Care Provider/Practitioner: DR. RAFAEL O. MOLLEGA , JR. OF NORTHWEST FLORIDA, INC

Information about “1972625721” NPI (DR. RAFAEL O. MOLLEGA , JR. OF NORTHWEST FLORIDA, INC) exists in 1972625721 in HTML format HTML  |  1972625721 in plain Text format TXT  |  1972625721 in PDF (Portable Document Format) PDF  |  1972625721 in an XML format XML  formats.

NPI Number : 1972625721 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972625721",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DR. RAFAEL O. MOLLEGA , JR. OF NORTHWEST FLORIDA, INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "12671 US HWY 98 W",
    "SecondLineMailingAddress": "STE 216",
    "MailingAddressCityName": "DESTIN",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32550",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "850-269-3937",
    "MailingAddressFaxNumber": "850-269-1988",
    "FirstLinePracticeLocationAddress": "12671 US HWY 98 W",
    "SecondLinePracticeLocationAddress": "STE 216",
    "PracticeLocationAddressCityName": "DESTIN",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32550",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "850-269-3937",
    "PracticeLocationAddressFaxNumber": "850-269-1988",
    "EnumerationDate": "04/04/2007",
    "LastUpdateDate": "02/23/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "NELSON",
    "AuthorizedOfficialFirstName": "CHRISTINA",
    "AuthorizedOfficialMiddleName": "M",
    "AuthorizedOfficialTitle": "BOOKKEEPER/INSURANCE PERSONNEL",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "850-269-3937",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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