{
"Npi": {
"NPI": "1972745081",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GHANEM DAGHESTANI MD PA",
"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": "PO BOX 1348",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EDINBURG",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "78540-1348",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "956-542-8400",
"MailingAddressFaxNumber": "956-350-0802",
"FirstLinePracticeLocationAddress": "2717 MICHAEL ANGELO",
"SecondLinePracticeLocationAddress": "SUITE 303",
"PracticeLocationAddressCityName": "EDINBURG",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "78539-1408",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "956-687-4600",
"PracticeLocationAddressFaxNumber": "956-217-7099",
"EnumerationDate": "04/03/2009",
"LastUpdateDate": "04/21/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "04/13/2010",
"NPIReactivationDate": "04/21/2010",
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAGHESTANI",
"AuthorizedOfficialFirstName": "GHANEM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "956-687-4600",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RH0003X",
"TaxonomyName": "Hematology & Oncology Physician",
"LicenseNumber": "M2933",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}