{
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"FirstLineMailingAddress": "1603 STEVENS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40205-1042",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "502-451-5955",
"MailingAddressFaxNumber": "502-451-5925",
"FirstLinePracticeLocationAddress": "1603 STEVENS AVE",
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"PracticeLocationAddressTelephoneNumber": "502-451-5955",
"PracticeLocationAddressFaxNumber": "502-451-5925",
"EnumerationDate": "01/26/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROSZELL",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHYSICIAN PARTNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "37462",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}