NPI Code Detail JSON Logo

1992716450 NPI number — NORTH BAY MEDICAL GROUP, INC.

NPI Number: 1992716450
Health Care Provider/Practitioner: NORTH BAY MEDICAL GROUP, INC.

Information about “1992716450” NPI (NORTH BAY MEDICAL GROUP, INC.) exists in 1992716450 in HTML format HTML  |  1992716450 in plain Text format TXT  |  1992716450 in PDF (Portable Document Format) PDF  |  1992716450 in an XML format XML  formats.

NPI Number : 1992716450 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992716450",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NORTH BAY MEDICAL GROUP, INC.",
    "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": "3850 MONTGOMERY DR",
    "SecondLineMailingAddress": "SUITE D",
    "MailingAddressCityName": "SANTA ROSA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95405-5207",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-591-0619",
    "MailingAddressFaxNumber": "707-591-0617",
    "FirstLinePracticeLocationAddress": "3850 MONTGOMERY DR",
    "SecondLinePracticeLocationAddress": "SUITE D",
    "PracticeLocationAddressCityName": "SANTA ROSA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95405-5207",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "707-591-0619",
    "PracticeLocationAddressFaxNumber": "707-591-0617",
    "EnumerationDate": "08/10/2006",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KRAUT",
    "AuthorizedOfficialFirstName": "ERIC",
    "AuthorizedOfficialMiddleName": "JAMES",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "707-591-0619",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208600000X",
        "TaxonomyName": "Surgery Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "CA",
        "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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