{
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"EIN": null,
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"OrgName": "DR IBN IMANI, DPM LLC",
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"FirstLineMailingAddress": "216 W COLLEGE AVE",
"SecondLineMailingAddress": "#871",
"MailingAddressCityName": "TALLAHASSEE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32301-7737",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-402-9042",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1628 N PLAZA DR",
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"PracticeLocationAddressCityName": "TALLAHASSEE",
"PracticeLocationAddressStateName": "FL",
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"EnumerationDate": "04/12/2011",
"LastUpdateDate": "01/07/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IMANI",
"AuthorizedOfficialFirstName": "IBN",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.P.M.",
"AuthorizedOfficialTelephoneNumber": "850-402-9042",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213EP1101X",
"TaxonomyName": "Primary Podiatric Medicine Podiatrist",
"LicenseNumber": "PO2415",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}