{
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"FirstLineMailingAddress": "11802 N 56TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TEMPLE TERRACE",
"MailingAddressStateName": "FL",
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"FirstLinePracticeLocationAddress": "11802 N 56TH ST",
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"PracticeLocationAddressCityName": "TEMPLE TERRACE",
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"PracticeLocationAddressTelephoneNumber": "551-427-4435",
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"EnumerationDate": "01/11/2018",
"LastUpdateDate": "06/13/2023",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": [
{
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},
{
"TaxonomyCode": "111N00000X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}