{
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"FirstLineMailingAddress": "PO BOX 729",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "318-404-1956",
"FirstLinePracticeLocationAddress": "831 W MAIN ST",
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"PracticeLocationAddressCityName": "HOMER",
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"PracticeLocationAddressTelephoneNumber": "888-505-1989",
"PracticeLocationAddressFaxNumber": "318-404-1956",
"EnumerationDate": "11/21/2019",
"LastUpdateDate": "07/23/2024",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BANNISTER",
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"AuthorizedOfficialTelephoneNumber": "888-505-1989",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}