{
"Npi": {
"NPI": "1508850983",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOORE",
"FirstName": "JOHN",
"MiddleName": "THOMAS",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2154 SUTTON HOOTEN LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LA GRANGE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28551-8252",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "252-521-2957",
"MailingAddressFaxNumber": "252-566-2829",
"FirstLinePracticeLocationAddress": "2154 SUTTON HOOTEN LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LA GRANGE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28551-8252",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "252-566-3298",
"PracticeLocationAddressFaxNumber": "252-566-2829",
"EnumerationDate": "08/31/2005",
"LastUpdateDate": "02/17/2010",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "100460",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}