{
"Npi": {
"NPI": "1285341834",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DIRECT MEDICAL XPERIENCE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "11845 RETAIL DR # 1079",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WAKE FOREST",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27587-7352",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-944-9935",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4505 FAIR MEADOWS LN STE 215",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RALEIGH",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27607-6449",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-944-9935",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/02/2022",
"LastUpdateDate": "11/18/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DYER",
"AuthorizedOfficialFirstName": "DEAUNDRE",
"AuthorizedOfficialMiddleName": "ALFONZO",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.O.",
"AuthorizedOfficialTelephoneNumber": "919-944-9935",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}