{
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"FirstLineMailingAddress": "3001 DIVISION ST STE 204",
"SecondLineMailingAddress": "STE 204",
"MailingAddressCityName": "METAIRIE",
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"MailingAddressPostalCode": "70002-5855",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "504-541-5800",
"MailingAddressFaxNumber": "504-541-5801",
"FirstLinePracticeLocationAddress": "3001 DIVISION ST",
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"PracticeLocationAddressCityName": "METAIRIE",
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"PracticeLocationAddressFaxNumber": "504-541-5801",
"EnumerationDate": "04/25/2019",
"LastUpdateDate": "09/28/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOSTICK",
"AuthorizedOfficialFirstName": "ROBERT",
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"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "III",
"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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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."
}
}
}
}