{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "2600 VAN BUREN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOLLYWOOD",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33020-4818",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-921-7533",
"MailingAddressFaxNumber": "954-921-7505",
"FirstLinePracticeLocationAddress": "2600 VAN BUREN ST",
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"PracticeLocationAddressCityName": "HOLLYWOOD",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-921-7533",
"PracticeLocationAddressFaxNumber": "954-921-7505",
"EnumerationDate": "10/20/2010",
"LastUpdateDate": "10/20/2010",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GAY",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "954-921-7533",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "54112",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}