{
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"EIN": null,
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"FirstLineMailingAddress": "6464 W MAIN ST",
"SecondLineMailingAddress": "SUITE 7A",
"MailingAddressCityName": "BELLEVILLE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62223-3811",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-293-1785",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6464 W MAIN ST",
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"PracticeLocationAddressCityName": "BELLEVILLE",
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"PracticeLocationAddressTelephoneNumber": "618-293-1785",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/11/2014",
"LastUpdateDate": "03/11/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROOKS",
"AuthorizedOfficialFirstName": "SHRON",
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"AuthorizedOfficialTitle": "SOLE PODIATRIST",
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"AuthorizedOfficialCredential": "DPM",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Podiatric Clinic/Center",
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"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}