1972965655 NPI number — ROBERT JOHN NICKE M.D., J.D., M.B.A.

NPI Number: 1972965655
Health Care Provider/Practitioner: ROBERT JOHN NICKE M.D., J.D., M.B.A.

NPI Number : 1972965655 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972965655",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NICKE",
    "FirstName": "ROBERT",
    "MiddleName": "JOHN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D., J.D., M.B.A.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NICKE",
    "OtherFirstName": "ROBERT",
    "OtherMiddleName": "J.",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.D., J.D., M.B.A.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1608 INVERNESS CLFS",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BIRMINGHAM",
    "MailingAddressStateName": "AL",
    "MailingAddressPostalCode": "35242-3729",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "205-910-1095",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1608 INVERNESS CLFS",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BIRMINGHAM",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "35242-3729",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "205-910-1095",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/22/2016",
    "LastUpdateDate": "03/22/2016",
    "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": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "32022",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "D30387",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "ME39499",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}