Date: 2020/07/24 22:43:57 UTC-07:00
Type: Denizen Script
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"NPI": 1699546220, DEA_Identifier_1": "93420WI",
"Entity Type Code": 1,
"Replacement NPI": "",
"Employer Identification Number (EIN)": "228950301",
"Provider Organization Name (Legal Business Name)": "Doyle's Pharmacy",
"Provider Last Name (Legal Name)": "GRIFFITH",
"Provider First Name": "PATTY",
"Provider Middle Name": "N/A",
"Provider Name Prefix Text": "",
"Provider Name Suffix Text": "",
"Provider Credential Text": "M.D.",
"Provider Other Organization Name": "",
"Provider Other Organization Name Type Code": "",
"Provider Other Last Name": "",
"Provider Other First Name": "",
"Provider Other Middle Name": "",
"Provider Other Name Prefix Text": "",
"Provider Other Name Suffix Text": "",
"Provider Other Credential Text": "",
"Provider Other Last Name Type Code": "",
"Provider First Line Business Mailing Address": "2425 Sunset Blvd",
"Provider Second Line Business Mailing Address": "",
"Provider Business Mailing Address City Name": "HOUSTON",
"Provider Business Mailing Address State Name": "TX",
"Provider Business Mailing Address Postal Code": 77005,
"Provider Business Mailing Address Country Code (If outside U.S.)": "US",
"Provider Business Mailing Address Telephone Number": 7135261771,
"Provider Business Mailing Address Fax Number": 7135261775,
"Provider Enumeration Date": "5/23/20",
"Last Update Date": "6/8/20",
"NPI Deactivation Reason Code": "",
"NPI Deactivation Date": "",
"NPI Reactivation Date": "",
"Provider Gender Code": "F",
"Authorized Official Last Name": "",
"Authorized Official First Name": "",
"Authorized Official Middle Name": "",
"Authorized Official Title or Position": "",
"Authorized Official Telephone Number": "",
"Healthcare Provider Taxonomy Code_1": "207X00000X",
"Provider License Number_1": 12637,
"Provider License Number State Code_1": "TX",
"Healthcare Provider Primary Taxonomy Switch_1": "Y",
"Healthcare Provider Taxonomy Code_2": "",
"Provider License Number_2": "",
"Provider License Number State Code_2": "",
"Healthcare Provider Primary Taxonomy Switch_2": "",
"Healthcare Provider Taxonomy Code_3": "",
"Provider License Number_3": "",
"Provider License Number State Code_3": "",
"Other Provider Identifier_1": "93420WI",