{
"Npi": {
"NPI": "1396799615",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "COOPER",
"FirstName": "RONALD",
"MiddleName": "J",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7060 RAINBOW LAKE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKE TOMAHAWK",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54539-9303",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-892-6915",
"MailingAddressFaxNumber": "715-277-4577",
"FirstLinePracticeLocationAddress": "1111 DELAFIELD ST",
"SecondLinePracticeLocationAddress": "SUITE 219",
"PracticeLocationAddressCityName": "WAUKESHA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53188-3417",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-951-8508",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/20/2006",
"LastUpdateDate": "12/02/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "25226",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}