{
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"FirstLineMailingAddress": "6800 HILLTOP RD",
"SecondLineMailingAddress": "SUITE #102",
"MailingAddressCityName": "SHAWNEE",
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"MailingAddressPostalCode": "66226",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "913-745-5300",
"MailingAddressFaxNumber": "913-745-5530",
"FirstLinePracticeLocationAddress": "1230 SW HARVEY ST",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "TOPEKA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "785-783-8559",
"PracticeLocationAddressFaxNumber": "785-783-8562",
"EnumerationDate": "01/06/2008",
"LastUpdateDate": "03/11/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VAN CAMP",
"AuthorizedOfficialFirstName": "KIPP",
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"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "913-745-5300",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": "0525311",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}