{
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"NamePrefix": null,
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"FirstLineMailingAddress": "1482 S BRYANT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EDMOND",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73034-5752",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "405-715-3937",
"MailingAddressFaxNumber": "405-715-3938",
"FirstLinePracticeLocationAddress": "1482 S BRYANT AVE",
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"PracticeLocationAddressCityName": "EDMOND",
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"PracticeLocationAddressTelephoneNumber": "405-715-3937",
"PracticeLocationAddressFaxNumber": "405-715-3938",
"EnumerationDate": "12/02/2009",
"LastUpdateDate": "06/14/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRINDSTAFF",
"AuthorizedOfficialFirstName": "MICHAEL",
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"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "405-715-3937",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332H00000X",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}