{
"Npi": {
"NPI": "1598054058",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FLORIDA INSTITUTE OF RESEARCH, MEDICINE, AND SURGERY, P.A.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "70 W. GORE STREET,",
"SecondLineMailingAddress": "SUITE 100 CREDENTIALING DEPARTMENT",
"MailingAddressCityName": "ORLANDO",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32806-1124",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-426-8484",
"MailingAddressFaxNumber": "407-447-5229",
"FirstLinePracticeLocationAddress": "52 WEST GORE STREET",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ORLANDO",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32806-1114",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-426-8484",
"PracticeLocationAddressFaxNumber": "407-426-8586",
"EnumerationDate": "04/05/2011",
"LastUpdateDate": "04/05/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CECIL",
"AuthorizedOfficialFirstName": "LEE",
"AuthorizedOfficialMiddleName": "B",
"AuthorizedOfficialTitle": "CREDENTIALS/MNGD CARE COORDINATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPCS",
"AuthorizedOfficialTelephoneNumber": "407-426-8484",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0001X",
"TaxonomyName": "Radiation Oncology Physician",
"LicenseNumber": "601046",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}