{
"Npi": {
"NPI": "1457536302",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PETERMAN",
"FirstName": "ROBERT",
"MiddleName": "BRUCE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CRNA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3643 OAK RIDGE LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DOTHAN",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36303-8303",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-794-7705",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "400 N EDWARDS ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ENTERPRISE",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36330-2510",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "334-347-0584",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/09/2008",
"LastUpdateDate": "03/27/2010",
"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": "367500000X",
"TaxonomyName": "Certified Registered Nurse Anesthetist",
"LicenseNumber": "1-055052",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}