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"FirstLineMailingAddress": "75 GLAMORGAN ST",
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"EnumerationDate": "07/27/2006",
"LastUpdateDate": "10/11/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHITE",
"AuthorizedOfficialFirstName": "JESSE",
"AuthorizedOfficialMiddleName": "WILLIAM",
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"AuthorizedOfficialCredential": "P.T.",
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{
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},
{
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},
{
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
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{
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},
{
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},
{
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}
]
}
}
}