{
"Npi": {
"NPI": "1467400358",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "X",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ZELEM",
"FirstName": "JOHN",
"MiddleName": "DEMETRO",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "100 HOSPITAL ST",
"SecondLineMailingAddress": "SUITE 100A",
"MailingAddressCityName": "BOONEVILLE",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38829-3354",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-720-5131",
"MailingAddressFaxNumber": "662-720-5135",
"FirstLinePracticeLocationAddress": "100 HOSPITAL ST",
"SecondLinePracticeLocationAddress": "SUITE 100A",
"PracticeLocationAddressCityName": "BOONEVILLE",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38829-3354",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-720-5131",
"PracticeLocationAddressFaxNumber": "662-720-5135",
"EnumerationDate": "05/04/2006",
"LastUpdateDate": "07/08/2007",
"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": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "18717",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "019923",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}