{
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"FirstLineMailingAddress": "754 N SKYLINE DR",
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"MailingAddressCityName": "IDAHO FALLS",
"MailingAddressStateName": "ID",
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"FirstLinePracticeLocationAddress": "2325 CORONADO ST",
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"PracticeLocationAddressTelephoneNumber": "208-542-7021",
"PracticeLocationAddressFaxNumber": "208-542-7371",
"EnumerationDate": "08/27/2012",
"LastUpdateDate": "08/06/2015",
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"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
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}
},
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}
}