{
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"FirstLineMailingAddress": "6719 GALL BLVD",
"SecondLineMailingAddress": "STE 107 TEW A SAK MD",
"MailingAddressCityName": "ZEPHYRHILLS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33542-2568",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-782-4113",
"MailingAddressFaxNumber": "813-788-2460",
"FirstLinePracticeLocationAddress": "6719 GALL BLVD",
"SecondLinePracticeLocationAddress": "STE 107 TEW A SAK MD",
"PracticeLocationAddressCityName": "ZEPHYRHILLS",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "813-782-4113",
"PracticeLocationAddressFaxNumber": "813-788-2460",
"EnumerationDate": "10/22/2008",
"LastUpdateDate": "01/20/2009",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SAK",
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"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "813-782-4113",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Y00000X",
"TaxonomyName": "Otolaryngology Physician",
"LicenseNumber": "ME43869",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}