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1992785836 NPI number — ANGELA MARIE FOX-PUTNAM OD

NPI Number: 1992785836
Health Care Provider/Practitioner: ANGELA MARIE FOX-PUTNAM OD

Information about “1992785836” NPI (ANGELA MARIE FOX-PUTNAM OD) exists in 1992785836 in HTML format HTML  |  1992785836 in plain Text format TXT  |  1992785836 in PDF (Portable Document Format) PDF  |  1992785836 in an XML format XML  formats.

NPI Number : 1992785836 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992785836",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FOX-PUTNAM",
    "FirstName": "ANGELA",
    "MiddleName": "MARIE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "OD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "612 SOUTH MAIN STREET",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOUNT HOLLY",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28120-1653",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-822-0099",
    "MailingAddressFaxNumber": "704-822-0077",
    "FirstLinePracticeLocationAddress": "612 S MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MOUNT HOLLY",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28120-1653",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-822-0099",
    "PracticeLocationAddressFaxNumber": "704-822-0077",
    "EnumerationDate": "01/18/2006",
    "LastUpdateDate": "10/16/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "1387",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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