{
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"FirstLineMailingAddress": "1011 US HIGHWAY 72 E",
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"FirstLinePracticeLocationAddress": "1011 US HIGHWAY 72 E",
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"EnumerationDate": "10/09/2020",
"LastUpdateDate": "08/12/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAQUE",
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"AuthorizedOfficialCredential": "OD",
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"Taxonomies": {
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}