{
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"FirstLineMailingAddress": "14175 W INDIAN SCHOOL RD STE B4-491",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "623-535-9777",
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"FirstLinePracticeLocationAddress": "15547 N REEMS RD STE A",
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"PracticeLocationAddressFaxNumber": "623-236-3179",
"EnumerationDate": "08/30/2019",
"LastUpdateDate": "01/19/2022",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LUNDQUIST",
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"AuthorizedOfficialCredential": "D.O",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Neurological Surgery Physician",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}