{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "915 MAIN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TILLAMOOK",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97141-3815",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-842-4181",
"MailingAddressFaxNumber": "503-842-1147",
"FirstLinePracticeLocationAddress": "915 MAIN AVE",
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"PracticeLocationAddressCityName": "TILLAMOOK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-842-4181",
"PracticeLocationAddressFaxNumber": "503-842-1147",
"EnumerationDate": "01/30/2007",
"LastUpdateDate": "09/28/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILSON",
"AuthorizedOfficialFirstName": "DAVID",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "503-842-4181",
"Taxonomies": {
"Taxonomy": [
{
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "3336C0003X",
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}