{
"Npi": {
"NPI": "1730190455",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRUCE FREEDMAN DPM PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "P O BOX 1304",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RICHLANDS",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24641",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "276-964-9633",
"MailingAddressFaxNumber": "276-964-9633",
"FirstLinePracticeLocationAddress": "6719 GOVERNOR GC PEERY HWY",
"SecondLinePracticeLocationAddress": "STE 1900",
"PracticeLocationAddressCityName": "RICHLANDS",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24641-0349",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "276-964-9633",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/10/2006",
"LastUpdateDate": "04/23/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FREEDMAN",
"AuthorizedOfficialFirstName": "BRUCE",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "276-964-9633",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "351",
"LicenseNumberStateCode": "VA",
"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."
}
}
}
}