{
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"FirstLineMailingAddress": "801 W STATE ROAD 436",
"SecondLineMailingAddress": "SUITE 2003",
"MailingAddressCityName": "ALTAMONTE SPRINGS",
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"MailingAddressPostalCode": "32714-3054",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-834-0000",
"MailingAddressFaxNumber": "407-265-2237",
"FirstLinePracticeLocationAddress": "801 W STATE ROAD 436",
"SecondLinePracticeLocationAddress": "SUITE 2003",
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"PracticeLocationAddressTelephoneNumber": "407-834-0000",
"PracticeLocationAddressFaxNumber": "407-265-2237",
"EnumerationDate": "11/17/2010",
"LastUpdateDate": "11/17/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BACCHUS",
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"AuthorizedOfficialCredential": "MBA",
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}