{
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"FirstLineMailingAddress": "PO BOX 692",
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"MailingAddressCityName": "MINNEAPOLIS",
"MailingAddressStateName": "MN",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "13410 BRIAR FOREST DR",
"SecondLinePracticeLocationAddress": "SUITE 190",
"PracticeLocationAddressCityName": "HOUSTON",
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"EnumerationDate": "06/20/2014",
"LastUpdateDate": "03/14/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOCK",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "401-732-7325",
"Taxonomies": {
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"TaxonomyName": "Family Medicine Physician",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}