{
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"FirstLineMailingAddress": "2423 W DUNLAP AVE",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "602-424-4451",
"FirstLinePracticeLocationAddress": "2423 W DUNLAP AVE",
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"PracticeLocationAddressFaxNumber": "602-424-4451",
"EnumerationDate": "08/19/2006",
"LastUpdateDate": "08/23/2013",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOEHLE",
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"AuthorizedOfficialTelephoneNumber": "602-424-4450",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "OTC4006",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}