| Name | Description | Type | Additional information |
|---|---|---|---|
| ID | string |
None. |
|
| Name | Name |
None. |
|
| Address | Address |
None. |
|
| Phone1 | PhoneNumber |
None. |
|
| Phone2 | PhoneNumber |
None. |
|
| Fax | PhoneNumber |
None. |
|
| LicenseNumber | string |
None. |
|
| DEANumber | string |
None. |
|
| DEANumberSuffix | string |
None. |
|
| NPI | string |
None. |
|
| SPI | string |
None. |