{
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"EIN": null,
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"FirstName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1441 N 12TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHOENIX",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85006-2837",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "500 W 10TH PL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MESA",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85201-3298",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "480-461-2575",
"PracticeLocationAddressFaxNumber": "480-649-0994",
"EnumerationDate": "05/11/2006",
"LastUpdateDate": "10/12/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUNNELL",
"AuthorizedOfficialFirstName": "RONALD",
"AuthorizedOfficialMiddleName": "R",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "602-495-4000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "OTC 3572",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}