{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "JOHN V. BAKA M.D.P.A",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 604",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BENTON",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72018-0604",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-778-1000",
"MailingAddressFaxNumber": "501-778-1010",
"FirstLinePracticeLocationAddress": "1220 MILITARY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BENTON",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72015-2908",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-778-1000",
"PracticeLocationAddressFaxNumber": "501-778-1010",
"EnumerationDate": "07/13/2006",
"LastUpdateDate": "01/24/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BAKA",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "VINCENT",
"AuthorizedOfficialTitle": "PHYSICIAN",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "501-778-1000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "E0792",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}