{
"Npi": {
"NPI": "1063611465",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GORDON F. ROSE, PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "544 W UMPQUA ST STE 104",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROSEBURG",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97470-2999",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "541-673-3334",
"MailingAddressFaxNumber": "541-673-0814",
"FirstLinePracticeLocationAddress": "544 W UMPQUA ST STE 104",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROSEBURG",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97470-2999",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "541-673-3334",
"PracticeLocationAddressFaxNumber": "541-673-0814",
"EnumerationDate": "07/16/2007",
"LastUpdateDate": "02/01/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROSE",
"AuthorizedOfficialFirstName": "GORDON",
"AuthorizedOfficialMiddleName": "FREDERIK",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "541-673-3334",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "MD15903",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}