{"npi":"1083602015","type":"NPI-2","status":"active","name":{"display":"M & T Dermatology Services LLC","other":[],"organization_name":"M & T DERMATOLOGY SERVICES LLC","authorised_official":"Mark Matlock"},"specialty":{"primary_taxonomy":"207N00000X","primary_taxonomy_description":"Dermatology","slug":"dermatology","schema_org_specialty":"Dermatologic","all":[{"code":"207N00000X","description":"Dermatology","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"2829 S JACKSON AVE","city":"JOPLIN","state":"MO","postal_code":"648042525","country_code":"US","phone":"4176240440","fax":"4176249652"},{"purpose":"MAILING","street_1":"2829 S JACKSON AVE","city":"JOPLIN","state":"MO","postal_code":"648042525","country_code":"US","phone":"4176240440","fax":"4176249652"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"506068501","state":"MO","issuer":null},{"type_code":"01","label":"Other","value":"DA0571","state":null,"issuer":"RAILROAD MEDICARE"}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2005-10-13","last_updated":"2008-11-19","_meta":{"source":"NPPES","snapshot_date":"2008-11-19","doc_url":"https://findmynpi.com/api"}}