{
"Npi": {
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"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
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"LastName": "MOEDE",
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"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1414 NARCISCO ST NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALBUQUERQUE",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87112-6536",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-293-3767",
"MailingAddressFaxNumber": "505-293-1969",
"FirstLinePracticeLocationAddress": "1414 NARCISCO ST NE",
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"PracticeLocationAddressCityName": "ALBUQUERQUE",
"PracticeLocationAddressStateName": "NM",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-293-3767",
"PracticeLocationAddressFaxNumber": "505-293-1969",
"EnumerationDate": "05/02/2007",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0800X",
"TaxonomyName": "Recovery Care Clinic/Center",
"LicenseNumber": "96-105",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}