{
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"FirstLineMailingAddress": "501 S. LINCOLN AVE.",
"SecondLineMailingAddress": "STE#15",
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"FirstLinePracticeLocationAddress": "10125 W. COLONIAL DRIVE",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/15/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABOUD",
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"Taxonomies": {
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"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}