{
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"FirstLineMailingAddress": "396 N LOMBARDY LOOP",
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"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32259-5266",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "1409 KINGSLEY AVE",
"SecondLinePracticeLocationAddress": "SUITE 9G",
"PracticeLocationAddressCityName": "ORANGE PARK",
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"PracticeLocationAddressTelephoneNumber": "904-637-0037",
"PracticeLocationAddressFaxNumber": "904-639-6017",
"EnumerationDate": "11/23/2015",
"LastUpdateDate": "07/20/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SOLEYMANI",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "904-962-7396",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Internal Medicine Physician",
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"LicenseNumberStateCode": "ZZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}