{
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"FirstLineMailingAddress": "PO BOX 1000",
"SecondLineMailingAddress": "DEPT 457",
"MailingAddressCityName": "MEMPHIS",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38148-0001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "901-758-7888",
"MailingAddressFaxNumber": "901-387-5153",
"FirstLinePracticeLocationAddress": "4110 BRIARGATE PKWY STE 460",
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"PracticeLocationAddressCityName": "COLORADO SPRINGS",
"PracticeLocationAddressStateName": "CO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "719-364-6487",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/23/2007",
"LastUpdateDate": "10/04/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Surgery Physician",
"LicenseNumber": "MD45085",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}