{
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"FirstLineMailingAddress": "13131 TESSON FERRY RD",
"SecondLineMailingAddress": "SUITE 129",
"MailingAddressCityName": "SAINT LOUIS",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-842-4920",
"MailingAddressFaxNumber": "314-842-3230",
"FirstLinePracticeLocationAddress": "13131 TESSON FERRY RD",
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"PracticeLocationAddressCityName": "SAINT LOUIS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-842-4920",
"PracticeLocationAddressFaxNumber": "314-842-3230",
"EnumerationDate": "04/26/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BURMEISTER",
"AuthorizedOfficialFirstName": "R(RAY)",
"AuthorizedOfficialMiddleName": "WILLIAM",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "314-842-4920",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "25858",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}