{
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"FirstLineMailingAddress": "1 INDEPENDENCE PT",
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"FirstLinePracticeLocationAddress": "60 BEAR DRIVE",
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"EnumerationDate": "06/22/2005",
"LastUpdateDate": "09/03/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": "03/15/2006",
"NPIReactivationDate": "03/29/2006",
"GenderCode": "M",
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"Taxonomies": {
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"TaxonomyName": "Colon & Rectal Surgery Physician",
"LicenseNumber": "9908",
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}
},
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}
}