{
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"FirstLineMailingAddress": "383 CORBIN CENTER DR",
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"MailingAddressCityName": "CORBIN",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40701-1895",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "606-526-2934",
"MailingAddressFaxNumber": "606-526-2901",
"FirstLinePracticeLocationAddress": "202 KIDD DR",
"SecondLinePracticeLocationAddress": "SUITE 3",
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"PracticeLocationAddressTelephoneNumber": "859-228-0201",
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"EnumerationDate": "02/13/2012",
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"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
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"LicenseNumber": "PT004993",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}