{
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"FirstLineMailingAddress": "607 CORONA LOOP",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROSEBURG",
"MailingAddressStateName": "OR",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "607 CORONA LOOP RD",
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"PracticeLocationAddressCityName": "ROSEBURG",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/14/2012",
"LastUpdateDate": "08/14/2012",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRACKEN",
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"AuthorizedOfficialTelephoneNumber": "541-733-2909",
"Taxonomies": {
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"TaxonomyName": "Emergency Care Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}