{
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"FirstLineMailingAddress": "5 WENGER ROAD",
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"MailingAddressCityName": "ENGLEWOOD",
"MailingAddressStateName": "OH",
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"MailingAddressFaxNumber": "937-433-6520",
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"PracticeLocationAddressFaxNumber": "937-830-2227",
"EnumerationDate": "03/29/2007",
"LastUpdateDate": "08/22/2020",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "PALMER",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Procedural Dermatology Physician",
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}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}