{
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"FirstLineMailingAddress": "7244 FAR HILLS AVE",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "937-395-1300",
"MailingAddressFaxNumber": "937-395-1311",
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"EnumerationDate": "07/12/2006",
"LastUpdateDate": "05/28/2025",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "BUENAVENTURA",
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"AuthorizedOfficialCredential": "M.D.",
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"Taxonomies": {
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"TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}