{
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"FirstLineMailingAddress": "5670 94TH PL SW",
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"MailingAddressCityName": "MUKILTEO",
"MailingAddressStateName": "WA",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1638 E MAIN ST",
"SecondLinePracticeLocationAddress": "STE 202",
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"EnumerationDate": "05/29/2012",
"LastUpdateDate": "02/17/2014",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MUSTO",
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"AuthorizedOfficialCredential": "M.D.",
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"Taxonomies": {
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"LicenseNumberStateCode": "WA",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}