{
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"ParentOrgLBN": null,
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"OrgName": "FAMILY MEDICINE ASSOCIATES OF THE EMERALD COAST P A",
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "PO BOX 1646",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DESTIN",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32540-1646",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-269-2186",
"MailingAddressFaxNumber": "850-269-2341",
"FirstLinePracticeLocationAddress": "348 MIRACLE STRIP PKWY SW",
"SecondLinePracticeLocationAddress": "SUITE 23",
"PracticeLocationAddressCityName": "FORT WALTON BEACH",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-269-2186",
"PracticeLocationAddressFaxNumber": "850-269-2341",
"EnumerationDate": "12/12/2008",
"LastUpdateDate": "08/31/2010",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEURINDA",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "850-269-2186",
"Taxonomies": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}