{
"Npi": {
"NPI": "1235303009",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "R C NICHOLS JR MD PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 2506",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PANAMA CITY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32402-2506",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-769-0009",
"MailingAddressFaxNumber": "850-769-0070",
"FirstLinePracticeLocationAddress": "615 N BONITA AVE",
"SecondLinePracticeLocationAddress": "BAY REGIONAL CANCER CENTER",
"PracticeLocationAddressCityName": "PANAMA CITY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32401-3623",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-747-6972",
"PracticeLocationAddressFaxNumber": "850-747-6584",
"EnumerationDate": "04/14/2008",
"LastUpdateDate": "04/15/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NICHOLS",
"AuthorizedOfficialFirstName": "ROMAINE",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "850-769-0009",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QX0203X",
"TaxonomyName": "Radiation Oncology Clinic/Center",
"LicenseNumber": "ME0056785",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}