{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "MEDICAL STUDIO INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4312 PLAZA GATE LN S",
"SecondLineMailingAddress": "APT 101",
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32217-5411",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1437 FLAGLER AVE",
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"PracticeLocationAddressCityName": "JACKSONVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32207-8516",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-575-2285",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/28/2016",
"LastUpdateDate": "09/28/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MENCZELESZ",
"AuthorizedOfficialFirstName": "GABOR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "AUTHORIZED REPRESENTATIVE",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "904-575-2285",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "ME122201",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}