{
"Npi": {
"NPI": "1548301005",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHERN DELAWARE FOOT & ANKLE LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 772",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SEAFORD",
"MailingAddressStateName": "DE",
"MailingAddressPostalCode": "19973-0772",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "302-629-3613",
"MailingAddressFaxNumber": "302-629-2384",
"FirstLinePracticeLocationAddress": "543 N SHIPLEY ST",
"SecondLinePracticeLocationAddress": "SUITE C",
"PracticeLocationAddressCityName": "SEAFORD",
"PracticeLocationAddressStateName": "DE",
"PracticeLocationAddressPostalCode": "19973-2339",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-629-3000",
"PracticeLocationAddressFaxNumber": "302-629-3080",
"EnumerationDate": "02/09/2007",
"LastUpdateDate": "04/26/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEMON",
"AuthorizedOfficialFirstName": "BRADLEY",
"AuthorizedOfficialMiddleName": "T",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "302-629-3000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "E1-0000121",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}