{
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"FirstLineMailingAddress": "5040 W STATE ROAD 46 STE 1126",
"SecondLineMailingAddress": null,
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"MailingAddressStateName": "FL",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-878-4272",
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"FirstLinePracticeLocationAddress": "2915 LAKEVIEW DR STE 1061",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CASSELBERRY",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-790-7289",
"PracticeLocationAddressFaxNumber": "321-295-7978",
"EnumerationDate": "02/22/2021",
"LastUpdateDate": "01/10/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SLATER",
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"AuthorizedOfficialTelephoneNumber": "407-790-7289",
"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
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}
}