{
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"EIN": null,
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "4401 MANCHESTER AVE",
"SecondLineMailingAddress": "SUITE 103",
"MailingAddressCityName": "ENCINITAS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92024-4938",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "760-632-7246",
"MailingAddressFaxNumber": "760-942-8878",
"FirstLinePracticeLocationAddress": "4401 MANCHESTER AVE",
"SecondLinePracticeLocationAddress": "SUITE 103",
"PracticeLocationAddressCityName": "ENCINITAS",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-632-7246",
"PracticeLocationAddressFaxNumber": "760-942-8878",
"EnumerationDate": "07/09/2008",
"LastUpdateDate": "07/22/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAW",
"AuthorizedOfficialFirstName": "JAMES",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "760-632-7246",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207LP2900X",
"TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
"LicenseNumber": "A45657",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}