{
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"FirstLineMailingAddress": "149 E MAIN ST # 1117",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANDOVER",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44003-9479",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "440-293-5555",
"MailingAddressFaxNumber": "440-293-6643",
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"EnumerationDate": "02/22/2007",
"LastUpdateDate": "12/03/2009",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAISLEY",
"AuthorizedOfficialFirstName": "SAMUEL",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "D.O.",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}