{
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"FirstLineMailingAddress": "PO BOX 3229",
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"MailingAddressCityName": "PORTLAND",
"MailingAddressStateName": "OR",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "888-227-3312",
"MailingAddressFaxNumber": "425-276-3215",
"FirstLinePracticeLocationAddress": "1025 NW 14TH AVE",
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"PracticeLocationAddressCityName": "PORTLAND",
"PracticeLocationAddressStateName": "OR",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/16/2019",
"LastUpdateDate": "06/03/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANDERSON",
"AuthorizedOfficialFirstName": "DONALD",
"AuthorizedOfficialMiddleName": "WAYNE",
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"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": "JR.",
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"AuthorizedOfficialTelephoneNumber": "425-358-9786",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261Q00000X",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}