{
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"FirstLineMailingAddress": "PO BOX 890",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WARREN",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "71671-0890",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "870-367-8534",
"MailingAddressFaxNumber": "870-367-0264",
"FirstLinePracticeLocationAddress": "301 HIGHWAY 425 S",
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"PracticeLocationAddressCityName": "MONTICELLO",
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"PracticeLocationAddressTelephoneNumber": "870-367-8534",
"PracticeLocationAddressFaxNumber": "870-367-0264",
"EnumerationDate": "12/07/2007",
"LastUpdateDate": "08/28/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLAYCOMB",
"AuthorizedOfficialFirstName": "SCOTT",
"AuthorizedOfficialMiddleName": "C",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "870-367-8534",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207W00000X",
"TaxonomyName": "Ophthalmology Physician",
"LicenseNumber": "C7907",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}