| NPI | Name Prefix | First Name | Middle Name | Last Name | Name Suffix | Credential | Mailing Address1 | Mailing Address2 | Mailing City | Mailing State | Mailing Zip Code | Mailing Phone | Mailing Fax | Business Address1 | Business Address2 | Business City | Business State | Business Zip Code | Business Phone | Business Fax | Type | Classification | Specialization | License Number | License Number State | Creation Date | Last Update | 
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | Name Prefix | First Name | Middle Name | Last Name | Name Suffix | Credential | Mailing Address1 | Mailing Address2 | Mailing City | Mailing State | Mailing Zip Code | Mailing Phone | Mailing Fax | Business Address1 | Business Address2 | Business City | Business State | Business Zip Code | Business Phone | Business Fax | Type | Classification | Specialization | License Number | License Number State | Creation Date | Last Update |